DECCD Provider Change of Child/Ledger Info Form

Use this form to report problems with any information on the ledger including issues with rates, duplicate children, missing children and children who no longer attend and should be removed from the ledger.























If YES, Sign In/Sign Out Sheets must be submitted to DECCD. You may send documents through FAX, EMAIL, POSTAL MAIL or UPLOAD to this form.


Example: John Doe, Jane Doe, xx-xx-xxxx




John Doe, Jane Doe, xxxx xxx xxxxx




Example: John Doe, 0.00, 0.00


If YES, Sign In/Sign Out Sheets must be submitted to DECCD. You may send documents through FAX, EMAIL, POSTAL MAIL or UPLOAD to this form.


Example: John Doe, FT, FT/PT


If you would like to upload a copy of any document(s) that are required for the specific change you are trying to make, please upload the document(s) here.







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