NYC Form CS-274W, the “Request for Enrollment of Child with Provider,” is the document the New York City Human Resources Administration (HRA) uses to connect a child approved for subsidized care with the specific provider who will care for them, and to lock in the rates that provider will be paid. You fill out the parent section, your provider fills out their section and rate table, and the completed form goes to your HRA Benefits Access Center or Job Center (or through the ACS voucher channel if that is how your case is structured). Until it is submitted and authorized, ACS will not pay the provider.
Who Uses the Form
The CS-274W is for families receiving Cash Assistance through HRA who have been approved for child care services and have chosen a provider. It covers every provider type: licensed day care centers, registered family day care homes, and legally exempt arrangements such as a grandparent, neighbor, or informal caregiver watching the child at home. Providers have an equal stake in getting it right, because the certification section states plainly that a provider who does not list all of their rates on the form will not be paid.
What to Gather Before You Start
The form asks for different information from each side, so both the parent and the provider should come prepared.
From the parent or caretaker: full name, home address, telephone number, CA (Cash Assistance) case number, and ACCIS case number. You may include your Social Security number, but the form states you cannot be required to disclose it as a condition of child care eligibility.
From the provider: full name, Social Security number or Employer Identification Number, date of birth, the address where care is given, mailing address if different, telephone number, email, and an ACCIS Provider Number if one has already been assigned. Licensed or registered providers also need their license number, license type, and expiration date. A regulated provider without an ACCIS number yet must attach a copy of the license when the form is submitted.
Rates: weekly rates broken out by age group (infant, toddler, preschool, school age) and by full-time, part-time, and hourly care. Every provider except ACS-contracted programs completes the rate section.
Schedule: the child’s name, date of birth, the date care began, and the weekly hours showing which days (Monday through Sunday) and what start and end times the child will be in care.
Filling Out the Five Pages
Page 1: Parent and Caretaker Information
You fill in your personal details, case numbers, and contact information. Two yes-or-no questions at the bottom ask whether a parent is serving full-time in the U.S. military or is a member of a National Guard or military reserve unit. Answer honestly; the answers can affect how the case is handled.
Page 2: Provider Information and Rates
The provider fills in identifying information, licensing details if applicable, and the address where care will be given. The bottom half is the weekly rate table. Enter a rate for every age group and care level you actually serve, and leave a row blank only if you genuinely do not serve that category. The certification warns that an incomplete rate table means no payment, so completeness matters.
Page 3: Special Needs Rates and Weekly Schedule
If the provider charges different rates for children with special needs, those go in the table at the top of the page. Below that, fill in every child being enrolled under this form, with date of birth, the date care started, and the specific hours for each day of the week. ACS uses this schedule as the baseline when it compares attendance data against payment claims.
Pages 4 and 5: Certifications
Page 4 is the provider’s certification. By signing, the provider confirms they are enrolling the child, understand that payment flows only after ACS receives attendance data, and acknowledge that payment continues only while the parent’s Cash Assistance case stays active and the parent remains employed or in an approved activity. The provider also certifies that the rates charged for this child are no higher than those charged other families for a child of the same age, and that the parent will have unlimited access to the child and the premises during care hours. False information can lead to suspended or terminated payments and recovery of money the provider was not entitled to receive.
Page 5 is the parent or guardian certification. You sign to confirm that everything on the form is correct and that you understand your obligation to report any changes to HRA immediately. Below your signature is a “For Agency Use Only” box where the caseworker records whether child care has been authorized and the approved start date.
Extra Paperwork for Legally Exempt and Relative Providers
Licensed and registered providers submit only the CS-274W. If your provider is legally exempt (in-home, family, or group) or an informal caregiver, you also need one of two state forms from the New York State Office of Children and Family Services:
- OCFS-LDSS-4699 for legally exempt in-home child care (care given in the child’s own home).
- OCFS-LDSS-4700 for legally exempt family child care (care in the provider’s home) and legally exempt group programs.
Relative providers (grandparents, aunts, uncles, siblings) must also submit form CFWB-047, which authorizes a criminal background check before enrollment can be finalized and payments can start.
Legally exempt providers generally must also complete state-approved health and safety pre-service training before enrollment; relative-only providers are exempt from that training requirement.
Where to Submit It
Where the form goes depends on how your child care is funded.
If you receive Cash Assistance through HRA, bring the completed CS-274W and any supporting documents to your HRA Benefits Access Center or Job Center. The caseworker handles the authorization and completes the agency-use section on page 5.
If you have an ACS child care voucher instead, submit through the ACS Child Care Voucher Submission Portal, or mail the form to:
NYC Children – EDU
PO Box 40
Maplewood, NJ 07040
ACS reviews the documents and mails a child enrollment notice to both the parent and the provider once everything is approved.
After the Form Is Processed
Once ACS authorizes the enrollment, the provider can begin submitting attendance data, and payments are calculated from the rates on the CS-274W and the attendance records received. One important limit: the New York State Office of Children and Family Services sets maximum payment rates for providers in New York City, so even if a higher rate is listed on the form, reimbursement is capped at the OCFS market rate for that area and provider type.
Providers can track payment status at the Child Care Payment Portal (childcarepaymentportal.com) using their six- or seven-digit Provider Identification Number and the last four digits of their Taxpayer Identification Number. Payment questions can also go to the Child and Family Well-Being Call Center at 212-835-7610. A current IRS Form W-9 must be on file with ACS, and the TIN, name, and address on it must match IRS records; if they do not match, ACS is required to withhold 28 percent of payments under IRS backup withholding rules.
Mistakes That Delay Enrollment
A handful of errors come up over and over:
- Leaving rows blank in the rate table. The provider certification states that an incomplete rate table blocks payment entirely.
- Submitting the CS-274W without the required OCFS companion form (4699 or 4700) when the provider is legally exempt. ACS cannot process the enrollment without it.
- Missing the CA case number or ACCIS case number on the parent’s section, which prevents the caseworker from matching the form to the right benefits case.
- A regulated provider without an ACCIS Provider Number forgetting to attach a copy of their license. The form gets sent back.
After submission, anything that changes (a new provider, different hours, updated rates) has to be reported to HRA immediately. The parent certification on page 5 spells out that obligation, and skipping it can cause payment problems or overpayment recovery later.