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Download Number
 		Name Effective Date
CCA-1163A Affidavit of Immunization Exemption - For Household Members Age 13 and Younger 05/01/2023
CCA-1163A-S Afidávit de Exención de Vacunación - Para Miembros del Hogar de 13 años de edad y Menores 05/01/2023
CCA-1164A Affidavit of Immunization Exemption - For Children in Care 05/01/2023
CCA-1164A-S Afidávit de Exención de Vacunación - Para Menores Bajo Cuidado 05/01/2023
CCA-1170A Withdrawal or Termination Request for Child Care Providers 05/01/2023
CCA-1170AS Petición para el Retiro o Terminación de Solicitud - Para Proveedores de Cuidado de Niños 05/01/2023
CCA-1175A Landlord Permission to Provide Family Child Care Service 05/01/2023
CCA-1175A-S Autorización Para Operar un Servicio de Cuidado de Niños 04/01/2023
CCA-1176A Parent/Guardian Affidavit of Non-Compensated Child Care 07/01/2023
CCA-1176A-S Declaración Jurada del Padre o Tutor por Cuidado de Niños no Remunerado 07/01/2023

Download Number Name Effective Date
CCA-1175A Landlord Permission to Provide Family Child Care Service 05/01/2023
CCA-1175A-S Autorización Para Operar un Servicio de Cuidado de Niños 04/01/2023
CCA-1176A Parent/Guardian Affidavit of Non-Compensated Child Care 07/01/2023
CCA-1176A-S Declaración Jurada del Padre o Tutor por Cuidado de Niños no Remunerado 07/01/2023
CCA-1190A Tribal New Child Care Referral 07/01/2023
CCA-1197A Emergency Preparedness and Response Plan for Certified Family Child Care Providers 07/01/2023
CCA-1197A-S Plan de Preparación y Respuesta en Caso de una Emergencia para los Proveedores de Hogar Certificado para el Cuidado de Niños 07/01/2023
CCA-1198A Acknowledgement of Receipt and Understanding 07/01/2023
CCA-1198A-S Acuse de Recibo y Entendimiento 07/01/2023
CCA-1199A Emergency Preparedness & Response Planning 04/01/2022

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