Instructions for Form CCL.301 "Application for a Child Care Center, Preschool, Head Start" - Kansas

This document contains official instructions for Form CCL.301, Application for a Child Care Center, Preschool, Head Start - a form released and collected by the Kansas Department of Health & Environment. An up-to-date fillable Form CCL.301 is available for download through this link.

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CCL.301a
Rev. 5/2021
Kansas Department of Health and Environment
Bureau of Family Health
Child Care Licensing Program
1000 SW Jackson, Suite 200
Topeka, KS 66612-1274
Phone: 785-296-1270 Fax: 785-559-4244
Website: www.kdheks.gov/kidsnet
INSTRUCTIONS FOR COMPLETING THE APPLICATION FOR A
LICENSED CHILD CARE CENTER INCLUDING PRESCHOOLS AND HEAD STARTS
NEW APPLICANTS:
This includes all facilities required to be licensed; currently licensed programs that are moving, ownership
changes, and programs changing from one category to another.
You are required to include the date of your orientation on the application if you are applying for
a new license, moving, changing program type or changing ownership. If you have not attended
an orientation session, STOP and contact the local child care licensing surveyor for your county
at
http://www.kdheks.gov/bcclr/download/county_contacts.pdf
before submitting your application.
Applicants must complete ITEMS 1 THROUGH 10 BELOW. If you are applying for a NEW licensed
Child Care Center (including Preschools and Head Starts), return the required forms and fees to the
Kansas Department of Health and Environment (KDHE) at the above address.
**Form CCL.301b Application Checklist is available for your use and is required to be completed,
signed, and submitted with the application.
**If you are submitting an online application, ensure that all documents are attached prior to adding
payment information.
INTENT TO CONTINUE: COMPLETE THE FORMS LISTED UNDER 1, 3, 4, and 5 BELOW. If you are renewing your current
(ANNUAL RENEWAL)
license, return the required forms and the annual licensing fee to KDHE at the above address.
INTENT TO CLOSE:
If you are no longer operating your Child Care Center, Preschool, or Head Start, you must notify KDHE of
your closure. Complete Sections I (Notification of Closure), II and VI of the application and send it along
with your license to KDHE at the above address.
1.
INSTRUCTIONS FOR APPLICATION:
APPLICATION FOR LICENSE. Applications for a new license must be submitted a minimum of 90 days prior to the
anticipated opening date of the facility. Applications are processed in the order received. The facility is not authorized to
provide child care prior to receiving a temporary permit or license.
CLEARLY PRINT OR TYPE using black ink. Complete all statements and include all requested information as
attachments to the application. Please review the completed application prior to mailing to KDHE to be sure that all items
listed on the application are included and CAREFULLY CHECK the accuracy of the information you are submitting.
Incomplete applications may be returned.
TOTAL LICENSE CAPACITY OF THE FACILITY. Provide the requested capacity for the facility. Total capacity of a
facility will be determined by KDHE at the time of licensure. The maximum capacity of a facility is determined by program
director qualifications, available indoor and outdoor space for children, and fire approval.
SHOW FACILITY ADDRESS ON WEBSITE. Checking “yes” to this question authorizes KDHE to publish the facility
address and phone number on a compliance report made available to the public through an online compliance information
system.
YEAR FACILITY BUILT. If the facility was built before 1978, it may be helpful to review lead hazard prevention
information provided by the KDHE Healthy Homes and Lead Hazard Prevention Program. A pamphlet for child care
providers is available on the program’s website.
2.
ORIENTATION:
If you currently have a license and you are renewing your license, you do not need to complete this section. If you are
applying for a new license, moving, changing program type or ownership, please complete the date of your orientation. If
you have not attended an orientation session, STOP and contact the local child care licensing surveyor for your county at
http://www.kdheks.gov/bcclr/download/county_contacts.pdf
before submitting your application.
1
CCL.301a
Rev. 5/2021
Kansas Department of Health and Environment
Bureau of Family Health
Child Care Licensing Program
1000 SW Jackson, Suite 200
Topeka, KS 66612-1274
Phone: 785-296-1270 Fax: 785-559-4244
Website: www.kdheks.gov/kidsnet
INSTRUCTIONS FOR COMPLETING THE APPLICATION FOR A
LICENSED CHILD CARE CENTER INCLUDING PRESCHOOLS AND HEAD STARTS
NEW APPLICANTS:
This includes all facilities required to be licensed; currently licensed programs that are moving, ownership
changes, and programs changing from one category to another.
You are required to include the date of your orientation on the application if you are applying for
a new license, moving, changing program type or changing ownership. If you have not attended
an orientation session, STOP and contact the local child care licensing surveyor for your county
at
http://www.kdheks.gov/bcclr/download/county_contacts.pdf
before submitting your application.
Applicants must complete ITEMS 1 THROUGH 10 BELOW. If you are applying for a NEW licensed
Child Care Center (including Preschools and Head Starts), return the required forms and fees to the
Kansas Department of Health and Environment (KDHE) at the above address.
**Form CCL.301b Application Checklist is available for your use and is required to be completed,
signed, and submitted with the application.
**If you are submitting an online application, ensure that all documents are attached prior to adding
payment information.
INTENT TO CONTINUE: COMPLETE THE FORMS LISTED UNDER 1, 3, 4, and 5 BELOW. If you are renewing your current
(ANNUAL RENEWAL)
license, return the required forms and the annual licensing fee to KDHE at the above address.
INTENT TO CLOSE:
If you are no longer operating your Child Care Center, Preschool, or Head Start, you must notify KDHE of
your closure. Complete Sections I (Notification of Closure), II and VI of the application and send it along
with your license to KDHE at the above address.
1.
INSTRUCTIONS FOR APPLICATION:
APPLICATION FOR LICENSE. Applications for a new license must be submitted a minimum of 90 days prior to the
anticipated opening date of the facility. Applications are processed in the order received. The facility is not authorized to
provide child care prior to receiving a temporary permit or license.
CLEARLY PRINT OR TYPE using black ink. Complete all statements and include all requested information as
attachments to the application. Please review the completed application prior to mailing to KDHE to be sure that all items
listed on the application are included and CAREFULLY CHECK the accuracy of the information you are submitting.
Incomplete applications may be returned.
TOTAL LICENSE CAPACITY OF THE FACILITY. Provide the requested capacity for the facility. Total capacity of a
facility will be determined by KDHE at the time of licensure. The maximum capacity of a facility is determined by program
director qualifications, available indoor and outdoor space for children, and fire approval.
SHOW FACILITY ADDRESS ON WEBSITE. Checking “yes” to this question authorizes KDHE to publish the facility
address and phone number on a compliance report made available to the public through an online compliance information
system.
YEAR FACILITY BUILT. If the facility was built before 1978, it may be helpful to review lead hazard prevention
information provided by the KDHE Healthy Homes and Lead Hazard Prevention Program. A pamphlet for child care
providers is available on the program’s website.
2.
ORIENTATION:
If you currently have a license and you are renewing your license, you do not need to complete this section. If you are
applying for a new license, moving, changing program type or ownership, please complete the date of your orientation. If
you have not attended an orientation session, STOP and contact the local child care licensing surveyor for your county at
http://www.kdheks.gov/bcclr/download/county_contacts.pdf
before submitting your application.
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3.
BACKGROUND AND REGISTRY CHECK FORMS - CCL 002 and CCL 002a CCC-PS-HS Affiliate Roles
Complete the Background and Registry Checks for Child Care Facilities form CCL 002. CLEARLY PRINT OR TYPE
all information requested.
EVERY INDIVIDUAL WORKING, RESIDING, OR VOLUNTEERING IN A FACILITY MUST HAVE A COMPLETED
BACKGROUND AND REGISTRY CHECK. This includes yourself, any individual at least 10 years of age residing in the
facility, any individual working or volunteering in the facility and any individual whose activities involve supervised or
unsupervised access to children. DO NOT INCLUDE children enrolled for child care. New individual(s) must be submitted
for a background and registry checks and results received prior to being permitted to work, reside, or volunteer in a facility.
Fingerprint Background Checks: For certain individual(s) working, residing or volunteering in a facility a fingerprint-
based background check and fee may be required. KDHE will notify the applicant/licensee when fingerprint-based
background check(s) are required and when results are received. For additional information regarding the background
check process and fee(s), visit www.kdheks.gov/kidsnet.
4.
FIRE SAFETY:
NEW APPLICANTS: Contact the Kansas State Fire Marshal’s Office and obtain a fire safety approval. Approval must be
submitted with the application. A temporary permit or license will not be issued until fire approval is submitted. To obtain
the General Rules or Forms as well as obtain requirements for new programs, please contact the Kansas State Fire
Marshal’s Office one of the following ways:
ONLINE: Visit the website at www.kansas.gov/firemarshal.
TELEPHONE: If you do not have access to a computer, call the Kansas State Fire Marshal’s Office at 785-296-3401.
Request that instructions and forms for a Child Care Center or Preschool be mailed to you.
** Approval Documents should include the following:
Local Jurisdiction Approval Notice;
State Fire Marshal Plan Review Approval Letter;
Kansas State Fire Marshal Referral Letter.
INTENT TO CONTINUE/ANNUAL RENEWAL: A fire inspection will be conducted annually. The fire inspection report
must be provided to the surveyor for review during the annual inspection. If it has been more than one year since the last
fire safety inspection, contact the State Fire Marshal at 785-296-3401.
5.
FEES:
A.
LICENSE FEE:
A payment for the total license capacity of the facility as being requested by the new applicant or as stated on the most
current license must accompany the application. If payment is made by debit or credit card, complete information as
required on the application. If payment is made by check, cashier’s check or money order make payable to KDHE.
The license fee is not refundable. The license fee by type of license follows:
• Child Care Centers/Head Starts: $75 plus $1 for each child included in the license capacity as printed on the license
(no maximum). For example, the initial and annual fee for a license capacity of 120 children is $75 + $120 = $195.
• Preschools: For facilities with a license capacity of 12 or fewer children, $15. For facilities with a license capacity of
13 or more children, $35 plus $1 for each child included in the license capacity as printed on the license not to exceed
$75. For example, the initial and annual fee for a license capacity of 28 children is $35 + $28 = $63.
B.
LOCAL FEE:
KDHE contracts with local health departments or private contractors to provide local regulatory services. Private
contractors may charge a local fee. Please contact your local child care licensing surveyor to determine the amount of any
local fee(s) and submit that fee directly to the local health department or private contractor per their instructions.
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APPLICANTS FOR A NEW LICENSE MUST ALSO COMPLETE
AND SUBMIT THE FOLLOWING INFORMATION.
6.
VERIFICATION OF THE LEGAL OWNER OR OPERATOR:
Private/Individual Owner(s):
As of July 1, 2010, each applicant must be a high school graduate or the equivalent (GED) to apply for a license.
Submit a copy of the lease or deed for the property, and, pursuant to K.S.A. 1991 Supp. 74-139, a copy of the Social
Security Card, Driver’s License, or Birth Certificate for each owner. If located in a church, school, or other building not
owned by the individual(s), include authorization signed by the owner of the property granting permission for the
operation of the program on the premises. If more than one applicant is applying for a license, both applicants must sign
the initial application
Corporate and LLC/LLP Owners:
Submit the Federal Employer Identification Number (FEIN) and the Kansas Secretary of State’s Business Entity
Identification Number (BEIN). If located in a church, school, or other building not owned by the corporation, include
authorization signed by the owner of the property granting permission for operation of the program on their premises.
Governmental Agency including School District:
Submit the Federal Employer Identification Number (FEIN) assigned to the legal owner. If located in a church, school, or
other building not owned by the government agency, include authorization signed by the owner of the property granting
permission for the operation of the program on their premises.
7.
PROGRAM INFORMATION:
A.
Description of Services to be provided. Include information such as number and ages of children to be served,
meals/snacks (catered or prepared on the premises), transportation (why and how), educational services (program
plan/learning experiences), etc.
**If providing Infant Services refer to CCL.306 CCC Infant Unit Requirements for additional information.
Qualified Program Director. Provide documentation to verify the Program Director is qualified. Submit a KDHE
B.
Program Director Approval certificate if available. Please see K.A.R. 28-4-429 for more information. The Program
Director approval application is available on the KDHE website at:
www.kdheks.gov/kidsnet
8.
PHYSICAL PLANT INFORMATION:
A.
Floor Plan.
I. Submit a drawing of the building (all levels) showing how the units fit into the overall floor plan.
II. Specify the location and linear dimensions (label length and width, not total square footage) for each room/unit to be
used and mark all exits from each unit to be used for children’s activities. Include the kitchen layout and use (if
onsite).
III. Identify the room name/number for each unit (should align with KSFM approval).
IV. Identify the age groups to be served in each of the units.
V. Infant units must identify sleep space separate from the play space. Note the type and height of barrier or divider
that separates the sleep and play areas.
VI. Indicate the location and number of toilets, changing tables/diaper changing area (if applicable) and hand sinks in
the units and/or restrooms, the source of drinking water, and indicate how restrooms and drinking water are
accessed by the children.
VII. Mark all of the exits that lead directly to the outside.
VIII. Indicate on the floor plan which direction is north.
B.
Outdoor Play Area.
NOTE: Outdoor play area is not required for preschools unless the preschool program includes outdoor play. Outdoor
play space must be on the premises. OUTDOOR PLAY AREAS MAY NOT BE SHARED WITH ANOTHER
FACILITY OR PROGRAM.
I. Specify the location and linear dimensions of the fenced outdoor play area (label length and width, not total square
footage).
II. Identify the type and height of the fence (must enclose the play area).
III. Indicate the route children will take to enter and exit the playground.
IV. Indicate the location of drinking water and restrooms and route children will take to access them. NOTE: If the plan
is for children to access drinking water and restrooms inside the building, children must be supervised, and staff to
child ratio must be maintained on the playground.
V. Mark the location of stationary play equipment (swings, climbers, slides, etc.), and indicate the distance between
each piece.
VI. Specify the type of impact-absorbing material under and around stationary equipment and indicate the type of
outdoor surface material on the remaining playground.
VII. Indicate how shade will be provided to the children while on the playground throughout the day (if through trees,
canopies, etc., please mark the location).
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SANITARIAN’S APPROVAL:
9.
If the facility is not connected to public water or sewage, a sanitarian’s approval is necessary.
10. LOCAL CODE APPROVAL:
Local zoning codes and ordinances may prescribe other requirements for the legal operation of a preschool or a child care
center. Applicants must submit written approval from the appropriate city or county building codes offices indicating that
all local zoning codes have been met or that there are no zoning codes that apply.
** ADDITIONAL INFORMATION **
ANNUAL KDHE INSPECTION:
K.S.A. 65-512 requires that all licensed facilities be inspected at least once every twelve months. An initial,
scheduled inspection will be requested by KDHE when a complete application is received and the facility is ready for
occupancy. Your local child care licensing surveyor will make an ANNOUNCED initial inspection of the facility and the
surrounding outdoor area. All future inspections including compliance checks, complaint investigations and annual reviews
are UNANNOUNCED. The annual inspection will not necessarily occur at the time of your annual renewal date. KDHE
provides dates for inspection to the local child care licensing surveyor. Inspection dates may change from year to year. If
you have questions or comments about your inspection, please contact KDHE at 785-296-1270.
KDHE CHILD CARE FORMS:
Current KDHE forms are enclosed for your use. Please make copies of these forms for future program use. Destroy
all unused copies of out-of-date forms, if you have any. Forms are also available for download at the KDHE website
www.kdheks.gov/kidsnet.
REGULATORY QUESTIONS:
The local child care licensing surveyor is your first and primary contact for questions about your child care
facility, child care laws and regulations. Surveyors have a supply of Law and Regulation books. To request a
regulation book, contact your local surveyor or download the laws and regulations from the KDHE website at
www.kdheks.gov/kidsnet. Surveyors are also a good source of information about other local services including educational
opportunities that may be available to child care facility owners and staff.
OTHER INFORMATION:
Once you receive your Temporary Permit or License, you may be eligible for services provided by other agencies.
Child Care Reimbursement for families receiving assistance with child care. For more information about contracting
with the Department for Children and Families (DCF) to receive child care payments from families receiving assistance
with child care, please contact DCF at 1-888-369-4777. The local child care licensing surveyor or child care resource and
referral agency can provide you with the contact information for your area.
Child and Adult Care Food Program. You may be eligible for partial reimbursement for providing nutritious meals and
snacks to children in your care. Contact the food program sponsor serving your area. The local child care licensing
surveyor or child care resource and referral agency can provide you with the contact information for a sponsor in your area.
Child Care Resource and Referral Agencies are available to assist you with training and referral services. For more
information, contact the local child care resource and referral agency or Child Care Aware at 1-877-678-2548 or
www.ks.childcareaware.org.
Good Beginnings Last A Lifetime!
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