DECCD Service Request

Please DO NOT upload Parent Application Documents or Change of Provider documents to this form. To access the web form for Parent Application documents and Change of Provider forms, please click the Parent Document Upload link https://app.smartsheet.com/b/form/92ca98a8c3364fa298d7c05e2356cff5​.​ To access the web form for Provider Document Uploads, use the following link: https://app.smartsheet.com/b/form/dc884facd6fb4db9b2baea768d6b8c1e

This office is not the SNAP office or the Child Support Office. Please call 1-877-882-4916 for Child Support assistance.

Are you a/an ________________?*

Chose the option that best applies to your situation

Please enter your first and last name as it appears on your account. If you are a childcare provider, list your provider name as well.

Parent should list their 14 digit application number beginning with 201 and Providers should list their Provider ID Number.

Please list the children's names for this request as they appear on the application or certificate.

Issue Type*

In order for faster service, please list the primary issue type. *Note* This does not take the place of submitting the appropriate form to DECCD. All forms are available at www.mdhs.ms.gov under "For Parents" or "For Providers" links. You may upload the completed form to this request below.

Please let us know how we can assist you today.

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

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