DECCD Parent Change of Info Form


Please enter your first and last name as it appears on your account.




Please input the last four digits of your social security number. (Ex.xxx-xx-1234)


Ex. 750 N State St. Jackson, MS 39209


Ex. (000) 123-4567




Please list the MS county or put "Out of State." The counties are available on the dropdown menu.



ALL DOCUMENTS can be either FAXED, EMAILED, POSTAL MAIL to DECCD or UPLOADED to this form.
Details will be provided at the end of this form.



If Yes, Please enter the type of Address change. IMPORTANT: If your physical address changed, You MUST submit BOTH:
1. A Driver's License or valid government issued ID
2. Two different copies of bills (such as bank statement/utility/medical bill/cell phone bill) reflecting the new residence.
















ALL DOCUMENTS can be either FAXED, EMAILED, POSTAL MAIL to DECCD or UPLOADED to this form.
Details will be provided at the end of this form.






Any NEW CHILD must be added through the Application link on our website.
https://www.apps.mdhs.ms.gov/ccis/NewApplication/AppStartPage.aspx



Please submit a copy of the child's Long-Form Birth Certificate and Social Security Card





ALL DOCUMENTS can be either FAXED, EMAILED, POSTAL MAIL to DECCD or UPLOADED to this form.
Details will be provided at the end of this form.







If NO LONGER EMPLOYED:
~A 60 Day Job Search Period may be given to allow you to search for a NEW JOB, IF job loss is reported within 10 days of loss.
~ If you become employed during the 60 day Job Search Period, You must submit your TWO most recent check stubs OR a notarized letter on company letter head from your new employer indicating RATE of Pay, HOW OFTEN you are paid, HOW MANY HOURS per week you work, and your DATE OF EMPLOYMENT.
~ Failure to submit the documents before the end of the 60 Day Job Search Period will cause your certificates to terminate immediately and you will have to REAPPLY.



IF YES: Please submit your TWO most recent check stubs OR a notarized letter on company letter head from your new employer indicating RATE of pay, HOW OFTEN you are paid, HOW MANY HOURS per week you work, and your DATE OF EMPLOYMENT.






IF YES: Please submit your TWO most recent check stubs OR a notarized letter on company letter head from your new employer indicating RATE of pay, HOW OFTEN you are paid, HOW MANY HOURS per week you work, and your DATE OF EMPLOYMENT.





ALL DOCUMENTS can be either FAXED, EMAILED, POSTAL MAIL to DECCD or UPLOADED to this form.
Details will be provided at the end of this form.



If YES, Please submit a valid driver's license, government issued ID or court document granting legal name change.


(First Middle Last) Please enter your new name exactly as it appears on your new ID.



If YES, Please submit a valid driver's license, government issued ID or court document granting legal name change.


(First Middle Last) Please enter your old child's name exactly as it appeared on your account.


(First Middle Last) Please enter your child's new name exactly as it appears on their new ID.



This will allow you to temporarily cancel your certificate for the summer. You can request to have your certificate re-issued in the fall or when the child returns to school. You MUST contact DECCD when you want your certificate to be re-issued.





If you no longer need a childcare certificate, please let us know so that funding can be given to another child in need. By ending your certificate services for a child, you understand that if you should need a certificate in the future, you will need to REAPPLY for that child.


Please list the name(s) of your child(ren) who no longer need childcare certificates.





Fax Number: 601-359-4422

Email Address: ccpayment@mdhs.ms.gov

Mailing Address:
DECCD
P. O. Box 352
Jackson, MS 39205



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. Legible Photos or scanned PDFs of required documentation is acceptable.







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