Nebraska separates Family Child Care Home I and II applications and maintains a common operational forms list. Use the packet matching the program's license type.
Agency: Nebraska Department of Health and Human Services, Division of Public Health, Children's Services Licensing Paperwork source review: September 14, 2026
Use your print window to print on paper or save as a PDF. The organizer is a planning aid for your files.
Check the form and your provider type.
An official agency form is issued or listed by the agency; that label alone does not establish mandatory use. A required state form is identified as mandatory in the cited instructions. A required record identifies information you must maintain; its format may be flexible. An optional template is a suggested format. Official instructions / portal links explain the application or record process.
Read “Applies to” and “Format and applicability” for each item. Home, group-home, center, local licensing, food-program, and subsidy requirements can differ.
Application & renewal
01
Official agency form
Application for a Family Child Care Home I License
Apply for provisional or non-expiring operating licensure.
Applies to
Family Child Care Home I applicants
Who completes it
Owner/authorized agent
Where it goes
DHHS Children's Services Licensing; packet permits email documents with fee mailed separately, or a complete mailed packet.
When to use or update
Before initial licensure; operating application after the provisional year.
Format and applicability: Seven-page official PDF with document and submission instructions.
At enrollment and when vaccination information changes.
Format and applicability: Official PDF dated 2013; use current DHHS immunization requirements rather than treating its printed schedule as current advice.
Selected official forms and public instructions were reviewed on September 14, 2026. This is a practical starting list, not a complete certification of every record, retention period, local rule, or individual application.
Licensing application and annual fee obligations are distinct from background-check renewal.
CACFP and subsidy enrollment forms were not verified here.
Use the agency’s current original and revision instructions. Keep confidential child and staff records in your own secure record system.
Use this sheet to check which items apply to your program. A listed item or a checked box does not establish that your program meets licensing requirements.
Program / provider type:
Licensing office / reviewer:
Date checked / rule or packet edition:
Form or instruction
Applies? Yes / No / Ask
Received / completed
Location / next review
1. Application for a Family Child Care Home I License
2. Application for a Family Child Care Home II License
3. Children's Record (CRED-0364)
4. Immunization Record (CRED-0810)
5. Fire and Tornado Drill Record
6. Health Information Report (CRED-0915)
7. Child Care Criminal History Check Application (PH-20)
Other local or agency document
Food-program / subsidy documents
Questions and next steps
Ask about required format, signatures, submission, update triggers, and retention. Record the agency’s answer and the person or written source that confirmed it.
Companion to the Nebraska source review dated September 14, 2026. Provider Path educational planning sheet.
Use your existing tools alongside these sources.
Keep official licensing records with your program’s business records. Provider Path’s editable agreement, handbook, and daily forms can help organize your work; check the state instructions before choosing a format.
