Pennsylvania's official forms directory covers centers, group homes, and family homes. Several health and safety forms cite all three regulatory chapters; the certificate application is labeled CD 633.
Agency: Department of Human Services (DHS), Office of Child Development and Early Learning (OCDEL) 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 Certificate of Compliance — Center, Group, and Family Home
Form CD 633
Apply for a Certificate of Compliance using the designated application.
Applies to
Centers, group child care homes, and family child care homes
Who completes it
Legal entity/operator
Where it goes
Regional Child Development Office; use linked complete-application guidance.
When to use or update
When applying; confirm the current packet and submission instructions.
Format and applicability: Directory verified; direct CD 633 download could not be opened during research.
Document health status, care needs, medication, screenings, and immunizations.
Applies to
Children in centers, group homes, and family homes
Who completes it
Parent/provider and physician, CRNP, or physician assistant
Where it goes
Facility retains a copy.
When to use or update
Enrollment health documentation and updates by health professional; due dates depend on applicable rules.
Format and applicability: Directory calls it assessment; PDF title is Child Health Report. Immunization record may be attached.
Open official source: Child Health Report, CD 51 ↗https://www.pa.gov/content/dam/copapwp-pagov/en/dhs/documents/providers/documents/early-learning/certification/child-care-forms/CD%2051%20(formerly%20CY%2051)%20Child%20Health%20Assessment.pdf
03
Official agency form
Emergency Contact / Parental Consent Form
Form CY 867
Document emergency contacts, release persons, and activity/medical permissions.
Applies to
Centers, group homes, and family homes
Who completes it
Parent/guardian and provider
Where it goes
Original, child care space copy, and excursion copy as indicated.
When to use or update
Enrollment and periodic review; exact review interval not printed in the opened form.
Format and applicability: Official PDF; sign individual permissions, not only the general information section.
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.
CD 633's direct download was inaccessible during review; its current title and program coverage are verified in the agency directory.
This inventory does not independently establish that each operational PDF's exact layout is mandatory.
Child Care Works payment and CACFP claim documentation were not reviewed.
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 Certificate of Compliance — Center, Group, and Family Home (CD 633)
2. Child Health Report / Child Health Assessment (CD 51)
3. Emergency Contact / Parental Consent Form (CY 867)
4. Child Care Staff Health Assessment (CD 322)
5. Fire Drill and Fire Detection Log (CY 864)
6. Incident Report Form (CY 866)
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 Pennsylvania 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.
