Parent Document Submission

This document submission portal is used to submit necessary paperwork for your childcare case.

IMPORTANT INFORMATION:

Only PDF formatted documents will be accepted. No Exceptions!
Any pictures or Screenshots of documents (JPG file) will not be accepted! No Exceptions!
If you are a childcare provider submitting documents for a parent, please complete a separate submission for each parent
Childcare Certificates will not be accepted! No exceptions!

If you need to submit forms for a provider, please submit here.

You can still submit documents via mail, fax or drop box

Please Visit our CCAP Express Page here.

If you have any questions regarding your CCAP case, please email us at CCAPQuestions@actforchildren.org

Submission Date*

Parent First Name*

Parent Last Name*

Best Phone Number*

Helpful Tip: Please add best number to reach customer, if needed.

Child Care Case Number

Do not use Social Security Number or (-) between numbers

Example:12345678987654

Parent Date of Birth*

Form Submitted*

Helpful Tip: Please write the Childcare Case Number on document before submitting. This ensures documents are placed with the appropriate case.

Select

Other Document submitted*

Helpful Tip: Please write the Childcare Case Number on document before submitting. This ensures documents are placed with the appropriate case.

Document Submission Agreement*

Please read the Following Acknowledgments and check the box below:

"I acknowledge that the document(s) submitted is in PDF format and that any other format will not be accepted. If the document(s) is not accepted, I will receive an email letting me know that the document will need to be resubmitted in the correct format. The received date will be determined by the date the PDF is received.

"I acknowledge that childcare billing certificates submitted through this portal will not be entered. If I submit a childcare billing certificate through this portal, I will receive an email letting me know that my certificate will not be entered unless it is submitted via mail, fax, or drop box."

Email Address*

Please make sure your email address is correct!

Form Submission*

Form Submission

Drag and drop files here or

Send me a copy of my responses

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