Effective Date: 01/01/00

Reference: None

Policy Statement:

If a Child Care Application (Form 3455) or a Request for Redetermination (Form 3455E) is incomplete, give the client and/or provider an opportunity to provide the missing information.


These procedures apply to Child Care Resource & Referral Agencies and Site Administered Providers.


  1. Review the entire Child Care Application (Form 3455) or Request for Redetermination (Form 3455E) and identify all missing information needed to determine eligibility.
  2. If the missing information can be obtained over the phone, attempt to contact the client and/or provider by phone within the first 24 hours.
  3. If the attempt to gather the information over the phone is unsuccessful, send a Request for Additional Information Form within ten (10) business days of receipt of the Child Care Application (Form 3455) or Request for Redetermination (Form 3455E).
  4. Do not return the original application under any circumstances. If a signature is missing, send a copy of that page of the Child Care Application or the Request for Redetermination.
  5. Whether seeking additional information from the parent or provider, send an exact copy of the request to the other party.
  6. Always keep a copy of what was sent for the case record.
  7. The information requested must be returned within ten (10) business days. Responses may be hand-delivered, mailed, or faxed.
  8. If the Request for Additional Information is ignored, deny an initial application using reason code #14, or cancel a case being redetermined using reason code #64.
  9. If the Request for Additional Information is returned with partial information, send a second request allowing an additional ten (10) business days for the missing information to be returned.
  10. If the second Request for Additional Information form is not returned within ten (10) business days or is still incomplete, deny the application using reason code #14.