How to Fill Out Missouri Child Care Forms: Enrollment, Subsidy, and Licensing

Missouri child care forms fall into three tracks depending on what you are trying to do. Parents enrolling a child give a medical exam report and immunization record directly to the provider. Families seeking financial help complete Form MO 500-3469, the Child Care Subsidy application, online at childcare.mo.gov or by mail. Anyone opening a facility for more than six children files Form 3293 with the Office of Childhood at the Department of Elementary and Secondary Education (DESE).¹ Below is what each form requires and where it goes.

Enrollment Forms Parents Give the Provider

Two documents must be on file before a child starts at any licensed or registered facility. Both go to the provider, not to any state office.

Child Medical Examination Report

Every infant, toddler, and preschool-age child needs a medical examination report on file within 30 days of admission. The exam has to have been performed no more than 12 months before the enrollment date, and it must be signed by a licensed physician or by a registered nurse working under a physician’s supervision. The report covers health history, physical exam findings, known allergies, and any medical conditions the provider should know about. You can use DESE’s version, downloadable from dese.mo.gov/childhood/forms, or a form the facility supplies, as long as it captures the same information.²

If a parent files a signed statement objecting to the medical examination on religious grounds, the report requirement does not apply.²

Immunization Records

Missouri law prohibits a child from enrolling in a day care center, preschool, or nursery school serving ten or more children unless the child has been immunized according to the schedule set by the Department of Health and Senior Services, which follows the CDC Advisory Committee on Immunization Practices. Satisfactory evidence is a statement or certificate from a physician or health facility listing each vaccine and the exact date it was given.³

A child who has not completed every age-appropriate vaccination can still enroll in three situations:

The child has begun the vaccination series and is continuing on the recommended schedule.
A licensed physician certifies that immunization would seriously endanger the child’s health or life.
A parent or guardian files a written objection to immunization with the facility administrator.

Children who are homeless or in the custody of the Children’s Division may enroll without records initially but must present satisfactory evidence within 30 days. The facility administrator keeps immunization records for every enrolled child and submits an annual summary to the Department of Health and Senior Services by January 15.³

Child Care Subsidy Application

The Child Care Subsidy Program is run by DESE, not the Department of Social Services. You can apply online through the child care data system at childcare.mo.gov, or print and mail Form MO 500-3469. DESE also offers a “Do I Qualify?” pre-screening tool so you can check eligibility first. Help is available through the Missouri Childhood Resource and Referral Call Center at 573-415-8605.⁴

Income Limits to Check Before You Apply

For new applicants, adjusted gross household income cannot exceed 150 percent of the federal poverty level.⁵ Using the 2026 federal poverty guidelines, the 150 percent thresholds work out to roughly:⁶

Household of 2: $32,460
Household of 3: $40,980
Household of 4: $49,500
Household of 5: $58,020

Families already receiving a subsidy whose income later rises above 150 percent FPL may qualify for Transitional Child Care, with three tiers: up to 185 percent FPL (Level 1), up to 215 percent FPL (Level 2), and up to 242 percent FPL (Level 3).⁵

Supporting Documents You Attach to Form MO 500-3469

The application asks for proof of income and a qualifying activity such as employment or school enrollment. DESE publishes several companion forms:⁴

Form MO 500-3563, Employment Verification Form, completed by your employer to confirm work schedule and earnings.
Form MO 500-3565, Self-Employment Income Ledger, for self-employed applicants to document business income.
Form MO 500-3602, Incapacitated Caregiver Verification, when the primary caregiver has a medical condition that limits their ability to care for the child.
Form MO 500-3564, Medical Provider Statement of Special Needs, for children with documented special needs requiring additional care.

Naming Your Provider on the Application

There is no separate provider selection form. Form MO 500-3469 has a section where you list your provider’s name, DVN (vendor number), phone number, address, and the daily start and stop times care is needed.⁷ Once approved, DESE issues an Authorization Letter that spells out the sliding-fee copayment you pay the provider directly.⁸ If your provider charges more than the state’s maximum base rate, you pay the difference too.

Facility Licensing Application (Form 3293)

Anyone planning to operate a facility serving more than six children, or more than three children under age two, must obtain a license from the Office of Childhood. The licensing application is Form 3293, downloadable from the DESE website.⁹¹⁰

Space Measurements the Application Needs

Your licensed capacity is tied to physical dimensions. Under 5 CSR 25-500, the minimums are:¹¹

Preschool and school-age children: at least 35 square feet of usable indoor floor space per child.
Infants and toddlers in new facilities or new infant/toddler space: at least 45 square feet per child.
Two-year-olds in an infant/toddler unit: at least 35 square feet per child when the group is entirely two-year-olds.
Outdoor play area: at least 75 square feet per child at the time of use, with enough total area for one-third of licensed capacity at once and no less than 750 square feet total.

Accurate indoor and outdoor measurements go on the application so the state can set your approved capacity.

Background Checks and Health Statements for Staff

Every staff member with contact with children must register with the Family Care Safety Registry (FCSR). The FCSR checks child abuse and neglect records, the Employee Disqualification List, sex offender registry information, and foster parent licensing records, among others.¹² Registration is $15.00 per person, plus a $0.55 credit card processing fee for online submissions, through the DHSS Background Screening and Employment Eligibility System.¹³

You will also need a medical statement for each employee confirming they are free from communicable diseases. Completed FCSR screenings and health clearances for every staff member are prerequisites to the state issuing your license. Once open, facilities are inspected once a year for fire safety and sanitation and twice a year for licensing rule compliance, so the enrollment records, medical reports, immunization documents, and FCSR paperwork you keep on file all get looked at.⁹

Where Each Form Is Submitted

The destination depends on the form:

Enrollment and health forms (medical exam report, immunization records) go to the child care facility, which keeps them on file. They do not go to a state office.
Subsidy applications go to DESE, either online through childcare.mo.gov or by mail using the paper Form MO 500-3469.⁴
Licensing applications (Form 3293) go to the Office of Childhood. The specific method — online upload or mailing to a regional office — depends on the type of program.⁹

Online submissions generate an immediate electronic receipt, useful for tracking. Mailed documents take longer because of transit and manual data entry. If anything is missing, the reviewing office contacts you, so check every required field and attachment before you send.

Tax Forms Tied to Child Care Costs

Two federal forms come up at tax time. IRS Form W-10 is a one-page worksheet your provider fills out with their name, address, and taxpayer identification number, which you need to claim the Child and Dependent Care Credit on Form 2441. If your provider refuses to complete a W-10, keeping a copy of their Social Security card or a recent invoice showing their name and address counts as proof of due diligence.

Families with employer-sponsored benefits may also contribute to a Dependent Care Flexible Spending Account. For 2026 the maximum household contribution is $5,000 ($2,500 if married filing separately) under the standard statutory limit. Federal employees enrolled in FSAFEDS have a higher cap of $7,500 per household for 2026.¹⁴ Dependent care FSA dollars reduce your taxable income, but you cannot claim the same expenses for both the FSA and the Child and Dependent Care Credit, so choose whichever saves you more.

1
Missouri Department of Elementary and Secondary Education. Child Care
2
Cornell Law Institute. Missouri Code 5 CSR 25-400-125 – Medical Examination Reports
3
Findlaw. Missouri Revised Statutes 210.003
4
Missouri Department of Elementary and Secondary Education. Child Care Subsidy Information for Families
5
Missouri Department of Elementary and Secondary Education. 2010.045.00 Income Eligibility Guidelines
6
U.S. Department of Health and Human Services. 2026 Poverty Guidelines
7
Amazon Web Services. Application for Child Care Subsidy for Children and Families Paper Form
8
Missouri Department of Elementary and Secondary Education. Child Care Subsidy Payments
9
Missouri Department of Elementary and Secondary Education. Start a Child Care Program
10
Missouri Department of Elementary and Secondary Education. Application for License to Operate a Child Care Facility
11
Missouri Secretary of State. 5 CSR 25-500
12
DSS Manuals. Section 6, Chapter 19 (Background Checks), Subsection 3 – Family Care Safety Registry
13
Missouri Management and Advisory Commission. Family Care Safety Registry (FCSR) Fee Increase
14
FSAFEDS. Message Board