May 16, 2016

Dear Parent / Care Provider:

You have expressed interest in child care/day care reimbursement through Regional Center of the East Bay. Child care assistance is available to those who qualify, for times when parents are working or attending school outside of the home (school leading to employment), and when your child(ren) are not in school. RCEB funds child care/day care to assist only with the specialized portion of care the consumer may need due to his/her special care needs, and only when the need for child care/day care cannot be met through centers in the community or natural supports.

Please fill out the application (Form A) attached completely. The form must be signed by either both parents, or guardians, unless there is single parent custody. As part of the child care/day care application package you must include an original letter signed by your employer(s) on employer’s letterhead which verifies the hours and days you work, vacation accrual and holiday schedule. You must also attach your most recent consecutive paycheck stubs or W-2 as proof of income. If your child receives In Home Support Services (IHSS), please provide a copy of the approval letter. If self-employed, you must provide your most recent 1040 tax filing, including business income tax schedules. If you are attending school, you must provide documentation of paid enrollment with dates, times, and location of classes you will be attending.

Any missing information, conflicting information, blank spaces in the child care/day care application, or verification information not submitted will cause the form to be returned to, and will delay the processing of your application and authorization of your services.

If you have any questions, please feel free to contact me at .

Sincerely,

Case Manager

San Leandro (Main Office): 500 Davis Street, Suite 100 San Leandro CA 94577 Tel: 510 618.6100 Fax: 510.678.4100

Concord: 1320 Willow Pass Road, Suite 300 Concord CA 94520 Tel: 925 691.2300 Fax: 925 674.8001

Website: www.rceb.org

Child care/Day Care-English

Rev. 5/16

Windows User

2016-05-16

RCEB