The Care 4 Kids Parent-Provider Agreement is the form that ties your childcare provider to your approved Care 4 Kids case in Connecticut. You and your provider each complete a portion, both sign, and submit it to Care 4 Kids. Until that signed agreement is on file and approved, no subsidy payments go out, so this is the step that turns an approved application into actual help with your weekly childcare bill.
Where to Get the Form
Download the PPA from the forms page at ctcare4kids.com, where it is listed as “Parent Provider Agreement Form (PPA).”1CT Care 4 Kids. Care 4 Kids Forms You can also request a copy by calling 1-888-214-5437 or pick one up at the Rocky Hill office. The form is available in English and Spanish.
Fill it out with your provider in the same sitting if you can. Mismatched information between the parent section and the provider section is one of the most common reasons a PPA gets delayed.
Section 1: Parent Information
At the top of this section, check the box that describes why you are submitting the form. Choose “Application/Redetermination” for a new or renewing case, or “Reporting changes/new provider” if you are switching providers or updating your arrangement mid-cycle.2CT Care 4 Kids. Parent-Provider Agreement Form
Then enter your full legal name (last, first, middle initial), your Care 4 Kids case number, your home address, and at least one phone number. Your case number appears on any correspondence Care 4 Kids has sent you.
Section 2: Provider Information
Start by checking the provider type. The choices are:
- Licensed Child Care Center
- Licensed Group Child Care Home
- Licensed Family Child Care Home
- Licensed Youth Camp or Exempt Youth Camp
- Exempt Center-Based Program (school-based or municipal programs that pass OEC health and safety inspection)
- Unlicensed Relative Provider
The type you check determines which sub-section to complete.
Licensed Providers and Exempt Programs (Section 2A)
The provider enters the center or home name, the address where care is provided, their Care 4 Kids provider ID, and their license number. Accreditation from NAEYC, COA, NEASC, or NAFCC is noted here as well.2CT Care 4 Kids. Parent-Provider Agreement Form
Unlicensed Relative Providers (Section 2B)
This section runs longer because the state is verifying a safe arrangement without a license to lean on. The provider enters their name, home address, date of birth, gender, and Care 4 Kids provider ID if one has already been assigned. They indicate where care will happen (the child’s home, the provider’s home, or another location) and whether a working telephone is available there. The form asks whether the location has a smoke detector and a fire extinguisher. The provider also discloses the total number of children in their care, including their own, and how many are under age two. Three yes-or-no questions follow: whether the provider has ever been investigated by DCF, has any outstanding arrest warrants, or has been convicted of a crime.2CT Care 4 Kids. Parent-Provider Agreement Form
To qualify as an unlicensed relative provider, the person must be related to the child by blood, marriage, or adoption, meaning a grandparent, great-grandparent, aunt, uncle, or sibling who lives outside the child’s home. The provider must be at least 20 years old.3Care 4 Kids. Unlicensed Relative Providers
Section 3: Children and Schedule
List every child who will be in this provider’s care. For each one, enter the full name, date of birth, the date care started or will start, and the provider’s weekly charge for that child. If the provider charges a registration fee, note that amount separately. For an unlicensed relative provider, also check the relationship (grandparent or great-grandparent, aunt or uncle, or sibling).2CT Care 4 Kids. Parent-Provider Agreement Form
Below each child, fill in the weekly care schedule with start and end times for each day. The form allows two time blocks per day, which is useful if your child needs care before and after school. Check “Yes” if the schedule stays the same every week, “No” if it varies.
Make sure the hours you list match the work or school schedule you reported on your Care 4 Kids application. A mismatch here can reduce your approved hours or hold up the whole case.
Sections 4 and 5: Signatures
Section 4 is the provider’s certification. By signing, your provider confirms the information is accurate, agrees to accept Care 4 Kids payments, and acknowledges two deadlines in particular: changes must be reported within 10 days, and completed invoices must be submitted within 120 days to be paid. The form warns that providing false information can result in criminal penalties under Connecticut law.2CT Care 4 Kids. Parent-Provider Agreement Form
Section 5 is your certification. Your signature confirms the care arrangement is real and the costs are accurate, and it commits you to notifying Care 4 Kids within 10 days if you change providers, if your household income rises above 85% of the State Median Income, if you lose your job or stop your approved activity, if the child is no longer living in your home, or if you move.2CT Care 4 Kids. Parent-Provider Agreement Form
Both signatures must be originals. Print your name, then sign and date. An unsigned form will be sent back.
What Unlicensed Relative Providers Need Alongside the Form
Licensed providers generally already have their credentials on file with the Office of Early Childhood, so the PPA is often all they need to send. New providers who have never received state payments should be ready to submit a Form W-9 so Care 4 Kids can set up tax reporting.4Connecticut Medical Assistance Program. Provider Enrollment Application and Agreement
Unlicensed relative providers have two additional requirements that must be in motion for payments to start:
- A completed DCF Authorization for Release of Information form, which Care 4 Kids uses to run a background check through the Department of Children and Families. All unlicensed providers are subject to criminal background checks as well, and a conviction on the state’s crimes list makes the provider ineligible. State law authorizes checks against the sexual offender registry, the child abuse registry, and the Connecticut law enforcement database, and may require fingerprint-based state and national criminal history checks.3Care 4 Kids. Unlicensed Relative Providers5Connecticut Office of Early Childhood. Care 4 Kids Program Policy Transmittal
- Attendance at the mandatory provider orientation for home-based providers, which covers health and safety, child development, and Care 4 Kids billing. Bring photo ID, plan to stay for the full session, and note that attendees must be at least 20 years old. No childcare is provided during the training.6CT Care 4 Kids. Provider Orientation Registration
Get these in motion before or alongside submitting the PPA. A signed agreement waiting on background checks or orientation means no payments go out in the meantime.
How to Submit the Form
Send the signed PPA and any supporting documents to Care 4 Kids through one of three channels:
- Online upload at ctcare4kids.com/upload. Files must be JPG or PDF, no larger than 10 MB each, with a limit of five files per submission. Take photos in portrait orientation on a flat surface in good lighting.7CT Care 4 Kids. Submit Information
- Fax to 1-877-868-0871.8Connecticut Office of Early Childhood. Care 4 Kids
- Mail to Care 4 Kids, 55 Capital Boulevard, Rocky Hill, CT 06067.9CT Care 4 Kids. Contact Us
Pick one channel. Care 4 Kids warns that sending the same documents through multiple channels can slow processing rather than speed it up.7CT Care 4 Kids. Submit Information Keep copies of everything you send in case questions come up about your effective start date.
What Happens After You Submit
Processing times move with application volume. The Care 4 Kids website posts a live status tracker showing which submission dates are currently being worked. As of early June 2026, the program was processing waitlist-invited applications received around late August 2025 and new applications received in late May 2026.10CT Care 4 Kids. Document Processing Status Check that page rather than calling; it updates as the queue moves.
Once review is complete, you and your provider each receive written notification showing the approved hours and the reimbursement rate. If something is missing, you will get a notice explaining what Care 4 Kids still needs.
After approval, your provider receives a monthly electronic invoice through the provider portal listing each child, the approved level of care, the certificate dates, and the approved hours and days for the month. The provider confirms attendance, submits the invoice by the due date, and Care 4 Kids issues an electronic payment within 15 days.11CT Care 4 Kids. Provider Information
Reporting Changes Later
Both you and your provider must report changes within 10 days. Connecticut regulation lists what counts: your address, household composition, citizenship status, income, any change in your childcare arrangement (new provider, different location, different cost, different schedule), changes to your work or school hours, and high school attendance.12Cornell Law Institute. Connecticut Agencies Regulations 17b-749-19 – Changes in Eligibility or Benefits Report changes by phone, in writing, or through the online portal.
Switching providers requires a new PPA with the new provider’s information. Same form, same signature requirements, same submission process. Just check “Reporting changes/new provider” at the top of Section 1 instead of “Application/Redetermination.”
If Your PPA Gets Kicked Back
Most problems with a PPA are fixable. Common reasons for a bounce include hours on the form that don’t match your employment verification, a provider whose background checks haven’t cleared, and missing signatures. Correct the issue and resubmit rather than going through a hearing.
If Care 4 Kids denies your PPA or takes an adverse action on your case, you can request a fair hearing. If you file the request within 10 days of the action, you can ask that your benefits continue while the decision is pending.13Care 4 Kids. Hearing Request Form The Hearing Request Form is on the Care 4 Kids forms page.