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The form requests accreditation and licensing information, including age group served, hours and days of operation, and approval requirements for weekend non-traditional care. It gathers personal liability insurance details, lists adults and children living in the home when applicable, and includes compliance questions on complaints, enforcement actions, arrests involving children, special needs approval, medication administration authorization, and signature and date.",{"@graph":63,"@context":118},[64,80,101],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/non-traditional-care-ntc-provider-application/303749/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/non-traditional-care-ntc-provider-application/303749.png","ImageObject",442,249,{"name":88,"@type":89},"Violet","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-09-26","2026-09-19",true,{"@type":98,"interactionType":99,"userInteractionCount":79},"InteractionCounter",{"@type":100},"ViewAction",{"@type":102,"mainEntity":103},"FAQPage",[104,110,114],{"name":105,"@type":106,"acceptedAnswer":107},"What contact and billing information does the NTC provider application request?","Question",{"text":108,"@type":109},"It collects the address where care is provided, the billing address, a contact name, a provider telephone number, and primary/required email details for remittance notices.","Answer",{"name":111,"@type":106,"acceptedAnswer":112},"Which licensing and operational requirements are addressed in the form?",{"text":113,"@type":109},"It requests licensor name, child capacity, age group served, and hours/days of operation, including approval requirements to provide non-traditional care on Saturdays and Sundays from 6:00 am–6:00 pm.",{"name":115,"@type":106,"acceptedAnswer":116},"What insurance and compliance questions must be answered?",{"text":117,"@type":109},"It requires personal liability insurance with at least $500,000 day care coverage and asks about documented complaints in the past 12 months, license actions/enforcement, arrests/convictions involving children, approval to serve special needs children, and authorization to administer medications.","https://schema.org",{"og:url":78,"og:type":120,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":122,"canonical":78},"index,follow",{"doc_id":124,"site_id":56},303749,1790210608,{"code":4,"msg":5,"data":127},{"doc_id":124,"user_id":128,"nickname":88,"user_avatar":129,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":79,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":135,"language":136,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":137,"faqs":138,"seo_title":139,"seo_description":61,"update_tm":140,"read_time":76},4398048950312,"https://ap-avatar.wpscdn.com/avatar/400002538284de19e3c?_k=1778320343897328908","Child Care Aware® of America  \n1515 N. Courthouse Rd – 3rd Fl. , Arlington, VA 22201 NTC Provider Phone: 1-888-270-1086 option 1  \nNTC Provider Fax: 571-544-7082  \n[NTCprovider@usa.childcareaware.org](NTCprovider@usa.childcareaware.org)  \nNon-Traditional Care (NTC) Provider Application  \n\n| Provider/Program Doing Business As (DBA) Name:\u003Cbr>_____________________________________________________________________________________________________________________________ _____________________________ |\n| --- |\n| Tax Information:\u003Cbr>Provider / Program Tax Identification Number (TIN): |\n|  |\n| Type of Provider/Program (Check one)\u003Cbr>Family Child Care Home Group Home Center |\n| Provider/Program Contact Information\u003Cbr>Address where care is provided:\u003Cbr>Street Name and Number City State Zip Code\u003Cbr>Billing Address Same as Above\u003Cbr>\u003Cbr>Street Name and Number City State Zip Code\u003Cbr>Contact Name:\u003Cbr>Provider Telephone Number:\u003Cbr>Primary Email address:\u003Cbr>Remittance Email: All direct deposit payment remittance notices are sent by email. If you prefer remittance notices be sent to an email other than your primary contact, please list your preferred email(s) here: |\n| Accreditation Information If Applicable\u003Cbr>Centers:   Homes:\u003Cbr>☐ National Accreditation Commission ☐ National Association for Family Child Care\u003Cbr>☐ National Association for the Education of Young Children ☐ Child Development Associate Credential\u003Cbr>☐ National Early Childhood Program Accreditation ☐ Early Childhood Education/Child Development Degree\u003Cbr>☐ Accredited Professional Preschool Learning Environment (or transcript listing 24+ college credits in these areas)\u003Cbr>☐ American Montessori Society ☐ Association of Christian Schools International ☐ Association Montessori International / USA ☐ Council on Accreditation\u003Cbr>☐ Cognia Early Learning |\n\n\n| Licensing Information:\u003Cbr>Licensor Name:   Phone/Email: Child Capacity  \u003Cbr>Age Group Served  \u003Cbr>Hours and Days of Operation:  \u003Cbr>Provider must be approved with licensing to provide care Saturday and Sunday from 6:00 am – 6:00 pm\u003Cbr>Adults & Staff Members Over 18 years old:\u003Cbr>Please identify all adults at the facility including the license holder, employees, assistants, volunteers, and family members\u003Cbr>Name:   DOB:   Relationship to Provider:  \u003Cbr>Name:   DOB:   Relationship to Provider:  \u003Cbr>Name:   DOB:   Relationship to Provider:  \u003Cbr>Name:   DOB:   Relationship to Provider:  \u003Cbr>Name:   DOB:   Relationship to Provider:  \u003Cbr>Name:   DOB:   Relationship to Provider:   |\n| --- |\n| Children Under 18 Years Living in the Home if applicable\u003Cbr>Name:   DOB:   Relationship to Provider:  \u003Cbr>Name:   DOB:   Relationship to Provider:  \u003Cbr>Name:   DOB:   Relationship to Provider:  \u003Cbr>Name:   DOB:   Relationship to Provider:  \u003Cbr>Name:   DOB:   Relationship to Provider:   |\n\nPersonal Liability Insurance  \nPersonal Liability Insurance with a general aggregate amount of at least $500,000 day care coverage is required to be an approved NTC provider  \nPlease provide the following information:  \nName of Insurance Company:  \nPolicy Amount:  \nName and Phone number of Insurance Company:  \n________________________________________________________________________________________  \nPlease read the following questions, select your response, and sign and date below:  \nHas the facility had any documented complaints in the past 12 months: YES NO  \nHave you ever had your child care license suspended, revoked or subjected to enforcement action?: YES NO Have you ever been arrested/convicted of any crime involving children?: YES NO  \nIs the facility approved to serve special needs children?: YES NO  \nIs the provider authorized to administer medications? *Including insulin: YES NO  \nIs the facility approved to provide non-traditional care hours with the state?  \n*If no, please contact your licensor and adjust your days and hours of operation to meet program requirements of Saturday and Sunday from 6:00 am – 6:00 pm: YES NO  \nSignature Date  \n|  | 1 Name (as sho","cbCaieKBx8EB3SFb","https://ap.wps.com/l/cbCaieKBx8EB3SFb","pdf",392639,7,"English","# Provider/Program Information\n# Tax Information\n# Accreditation and Licensing\n# Insurance and Compliance Questions\n# Signature and Date","[{\"question\":\"What contact and billing information does the NTC provider application request?\",\"answer\":\"It collects the address where care is provided, the billing address, a contact name, a provider telephone number, and primary/required email details for remittance notices.\"},{\"question\":\"Which licensing and operational requirements are addressed in the form?\",\"answer\":\"It requests licensor name, child capacity, age group served, and hours/days of operation, including approval requirements to provide non-traditional care on Saturdays and Sundays from 6:00 am–6:00 pm.\"},{\"question\":\"What insurance and compliance questions must be answered?\",\"answer\":\"It requires personal liability insurance with at least $500,000 day care coverage and asks about documented complaints in the past 12 months, license actions/enforcement, arrests/convictions involving children, approval to serve special needs children, and authorization to administer medications.\"}]","Non-Traditional Care (NTC) Provider Application | PDF",1789806705]