Indiana CCDF Provider Information Form (State Form 57222): I-LEAD Submission

Indiana’s CCDF Provider Information form, State Form 57222, is the document you complete inside the I-LEAD portal at ilead.in.gov to become eligible for reimbursement through the state’s Child Care and Development Fund voucher program. You submit it along with an IRS Form W-9 and the Automated Direct Deposit Authorization Agreement (State Form 47551), and the Office of Early Childhood and Out-of-School Learning (OECOSL) verifies your eligibility through records and an on-site inspection before approving you to accept CCDF vouchers.¹

What the Form Actually Asks For

SF 57222 itself is short. You provide your legal name (or business name if applicable), your physical address, your provider type, and either the last four digits of your Social Security Number or your Employer Identification Number if you operate as a business.²

The form notes that eligible providers must demonstrate compliance with CCDF minimum standards before participating. Signing it is your attestation that you have met those standards. The state then verifies the attestation through records and the on-site inspection. That means the real work of completing SF 57222 is gathering the documents and credentials the form stands in for.

You can download the form from the Indiana state forms portal at forms.in.gov or access it directly inside I-LEAD when you file your application.

Pick Your Provider Type Before You Start

One field on the form drives a lot of what follows: your provider type. Indiana recognizes six categories for CCDF reimbursement under Indiana Code 12-17.2-3.5, and the one you select determines which second orientation you take and which licensing or exemption rules apply to you.³ The categories are Licensed Center, Licensed Home, Unlicensed Registered Child Care Ministry, Legally License Exempt Home, Legally License Exempt Child Care Facility, and Voluntary Certification Program (VCP) Ministry.⁴

If you are unsure which fits your operation, submit the Emerging Provider Referral Form on the OECOSL site first. A specialist will walk you through the specific requirements for your type before you start the application.⁵

What to Have Ready Before You Open I-LEAD

Because SF 57222 is an attestation, filing it without the underlying documentation in hand will stall your application. Gather all of the following first.

IRS Form W-9

The state uses the W-9 to verify your taxpayer identification with the IRS. No reimbursement payments will be issued until that verification clears, so a mismatch between the name and TIN you report on SF 57222 and what the IRS has on file will delay you even after approval.⁶

Direct Deposit Authorization (SF 47551)

You need your bank’s nine-digit routing number and your account number, which can be up to 17 digits including any leading zeros. Errors in either number will delay payments, and you will have to submit a new form to correct them.⁷

CPR and First Aid Certifications

Every provider, employee, caregiver, and volunteer who serves as a caregiver must hold current First Aid certification. At least one adult with annual CPR certification covering every age group in your care must be on-site whenever children are present.⁸

TB Testing Records

The provider, any household member 18 or older in a home-based program, and every employee, caregiver, and volunteer must have proof of a current tuberculosis test before starting. Anyone with a history of latent or active TB needs annual physician documentation of symptom screening results.⁸

Completed Orientation Modules

Two orientations are required. Orientation 1 covers the general start-up process for all childcare providers. Orientation 2 is tailored to your provider type, with separate versions for centers, home providers, unlicensed registered ministries, and the other categories. Both live inside Indiana Learning Paths in the I-LEAD portal.⁵

Health and Safety Training

Beyond the orientations, the state requires health and safety training covering 11 topic areas, including infectious disease control, medication administration, food and allergy emergencies, premises safety, emergency preparedness, hazardous materials, safe transportation, safe sleep practices, child abuse recognition and reporting, First Aid and CPR, and child development domains. The training is available through Indiana Learning Paths. The state will not process your eligibility until it is complete.⁹

Background Checks

Everyone with regular contact with children in your program must clear a background check. The state does not charge fees. The screening pulls fingerprint-based criminal history from both the FBI and Indiana databases, searches the Indiana sex offender registry, and searches the state’s Child Protection Index.¹⁰ Federal law adds a search of the National Crime Information Center’s National Sex Offender Registry, and for anyone who has lived in another state within the past five years, checks of that state’s criminal registry, sex offender registry, and child abuse database.¹¹

Certain convictions disqualify you outright. Under Indiana Code 12-17.2-3.5, a provider is ineligible if they, anyone residing in a home-based program, or any employee or volunteer present during operating hours has been convicted of a felony related to child safety, a sex offense, a dangerous felony, or a misdemeanor involving child health or safety or welfare fraud. For other felonies, at least ten years must have passed since discharge from probation, imprisonment, or parole.³

Facility Readiness

You are attesting on the form that your site meets CCDF health and safety standards, so walk through the inspector’s checklist before you submit:⁸

Smoke detectors at the top of each stairwell (except the basement), near the sleeping area, and in the basement.
A 2.5-pound or larger ABC multipurpose fire extinguisher on every floor, plus an additional one in the kitchen.
Two exits on different sides of the facility, unblocked, operable from inside without a key, and not requiring passage through a garage or hazardous storage area. A balcony exit must have permanent stairs to the ground.
Documented monthly fire drills following fire prevention and building safety commission rules.
Hot and cold running water from an approved source in the childcare area, reaching at least 100°F. A non-municipal supply requires a water quality test on file.
A working telephone plus a communication device compatible with the state’s automated time and attendance system.
Firearms, poisons, and chemicals inaccessible to children.
Written plans for notifying parents of illness, serious injury, or death of a provider, and emergency evacuation plans posted in plain view.

You also need a written substance policy. Home-based providers must prohibit the use of tobacco, alcohol, and illegal substances on the premises during childcare hours. Centers and ministries follow a stricter version that also prohibits possession of alcohol and illegal substances on site.¹²

Unlicensed registered child care ministries have one additional step before the OECOSL inspection: a completed application packet submitted to the Department of Homeland Security, Fire and Building Safety Division.⁵

Submitting Through I-LEAD

Log into I-LEAD at ilead.in.gov and file SF 57222, your W-9, your direct deposit form, and any supporting documents through the application module. OECOSL then schedules an on-site inspection. For legally license exempt providers, the inspection is unannounced, and the consultant verifies compliance with every applicable item on the Provider Eligibility Standard checklist.¹³ Approval follows a successful inspection and IRS verification of your W-9.

If you cannot complete the enrollment requirements or refuse to provide the necessary information, any vouchers already assigned to you will be ended, and the family will have to choose a different provider.⁶

After Approval: Payment Submission Rules

Once approved, you register with the state’s payment vendor and begin accepting vouchers. Reimbursement rates depend on the child’s age, your program type, and your Paths to QUALITY level. Funds transfer to your bank account every two weeks on Thursdays, 19 days after the last day of a two-week service period. You have two weeks after a service period ends to submit your payment request. Miss a submission and all future payments are held until the missed period is submitted, and periods must be submitted in order from oldest to newest.⁶

A child marked present for any part of a day counts as a full day. You are paid the full-time rate for every enrolled child until that child accumulates 45 absences in an enrollment year.

Staying Eligible

CPR and First Aid certifications must stay current. Background checks must stay clean for everyone with access to children during operating hours. Fire drills must be run and documented every month. Emergency plans must stay posted and current. Indiana can revoke your CCDF eligibility if you fall out of compliance, and a provider whose eligibility has been revoked cannot reapply for two years, regardless of the reason.³

1
Indiana State Government. Child Care Assistance
2
Family and Social Services Administration. Indiana CCDF Provider Form SF 57222
3
Indiana General Assembly. Indiana Code 12-17.2-3.5 – Eligibility of Child Care Provider to Receive Reimbursement Through Voucher Program
4
Indiana Family and Social Services Administration. CCDF Provider Manual Revised April 2025
5
Indiana Family and Social Services Administration. Become a Child Care Provider
6
Indiana Family and Social Services Administration. CCDF and On My Way Pre-K Provider Manual
7
State of Indiana. Automated Direct Deposit Authorization Agreement
8
Indiana Family and Social Services Administration. CCDF Provider Eligibility Standards Summary
9
Indiana Family and Social Services Administration. New Health and Safety Orientation Training Requirement
10
Indiana Family and Social Services Administration. Background Check Requirements
11
Administration for Children and Families. Guidance on Background Checks of Child Care Staff
12
Indiana General Assembly. Indiana Code 12-17.2-3.5-12.1 – Drug Testing
13
Indiana Family and Social Services Administration. The Monitoring Process for Child Care Programs in Indiana