Form IL444-3455G – Request for Child Care Provider Change

Jurisdiction: USA | Illinois

What is an IL444-3455G – Request for Child Care Provider Change?

The IL444-3455G is a state form you use to change the child care provider on your child care assistance case. It tells the State of Illinois which provider should receive payment for your child’s care going forward. The form belongs to the State of Illinois, Department of Human Services, Bureau of Child Care and Development.

You complete this form when you want the state to stop paying your current provider and start paying a new one. The form captures who you are, which children are affected, who the new provider is, and when the change should start. It also records your child’s schedule and the rate the provider charges. Your signature and the provider’s signature confirm the details.

Who typically uses this form?

Parents and legal guardians who have an active child care assistance case. Teen parents and caretaker relatives may also use it if they are the case head. Providers use it too. The provider section confirms their identity, rate, and agreement to program rules.

Why would you need this form?

You need it any time you switch child care settings while on assistance. The program must know where your child attends care and who to pay. Without this form, your old provider remains on file. Payments will not shift to the new provider.

Typical usage scenarios

• You move to a new neighborhood and choose a new center near your home.
• Your work shift changes, and you need evening or weekend care.
• Your current provider closes, changes ownership, or can no longer serve your child.
• Your child needs a program that better matches school hours or special needs.
• Summer break starts, and you move from after‑school care to a full‑day camp.
• Your child starts school, and you switch to a before‑ and after‑school program.
• The provider’s legal entity changes, so a new payee must be set up.

The form does not change your eligibility. It updates who the state pays for care during your approved eligibility period. You still must meet program rules. The new provider must be eligible to receive payments. The state will not issue payment to an ineligible provider.

Using the form keeps everyone aligned. Your prior provider gets a clear end date. Your new provider gets a clear start date. The state ties payments to the correct dates, rates, and schedules. You avoid gaps or overpayments.

When Would You Use an IL444-3455G – Request for Child Care Provider Change?

You use this form as soon as you know your child will leave one provider and start with another. Send it before the first day at the new site when possible. That helps avoid unpaid days. The program cannot pay a provider until the change is on record and the provider qualifies.

Here are practical examples. You start a new job across town with a 6 a.m. shift. Your current provider opens at 7 a.m., so you select a licensed home nearby that opens early. You complete the form to end the old provider on Friday and start the new provider on Monday.

Your child becomes school‑age in the fall. You switch from full‑day care to an after‑school program and a summer camp. You file a provider change at the end of summer to move back to the after‑school site. You also filed another change at the start of the next summer to return to full‑day care.

Your provider sells the center to a new owner. The legal payee changes. Even if your child stays in the same building with the same staff, the state may need to pay a different business entity. You file the form, so the payment goes to the new payee. The old payee should stop billing after the transfer date.

Your provider loses eligibility or closes. You must move care promptly. You file the form to add a new eligible provider. This prevents a gap and helps avoid out‑of‑pocket costs that the state cannot reimburse.

You might also use the form when your child splits care during the school year. For example, a school program handles afternoon care, and a different provider covers school closures. If the program allows a second provider for the same child, you use the form to add that provider. The program will decide if a split arrangement is allowed.

Typical users are parents and guardians with active cases. Providers complete their portions to accept the child and confirm their rates and hours. Program staff then process the request. They will confirm eligibility, provider status, and the effective dates.

Use the form promptly. The state pays providers directly. It does not reimburse parents for care paid before approval. If you start care without submitting the form, you risk paying the full cost yourself.

Legal Characteristics of the IL444-3455G – Request for Child Care Provider Change

This form is a formal program document. It directs the state to update the payee on your case. It is not a private contract between you and your provider. It sits inside the rules of the child care assistance program. Your signature certifies that the information is true and complete. The provider’s signature certifies their rate, schedule, and agreement to program rules.

Is it legally binding?

Yes, in the sense that your signed statements carry legal weight. You attest that you need care for work, school, or an approved activity. You attest to the accuracy of the start date, schedule, and provider information. False statements can lead to penalties. Those can include overpayment recovery, case sanctions, termination, or referral for fraud investigation.

What ensures enforceability?

Several things. The program requires your signature and the provider’s signature. The form includes warnings about false statements and penalties. It requires taxpayer information for the provider if needed for payment. The program verifies licensing or exemption status. It may conduct background checks where required by law. It can request supporting records, such as attendance or work schedules.

Payments depend on provider eligibility. The state can approve the provider only if they meet program requirements. Licensed providers must have a valid license. License‑exempt providers must meet standards and complete required checks and documents. If the provider is not eligible on the start date, the program will not pay them. Approval is not guaranteed.

The form also interacts with your ongoing eligibility. Your eligibility period remains the same unless you separately report a change that affects it. Your family fee (co‑pay) is set by the program based on your case. Switching providers does not change the fee by itself. You will pay your co‑pay to the new provider once the change takes effect.

The program may limit backdating. Do not assume you can backdate the start to cover past care. The state can deny payment for days before the provider is approved or before the request is received. If there is a break or overlap, the state may allow payment only for eligible days, subject to its rules. Overlapping payments to two providers for the same time is generally not allowed.

Privacy rules apply. The form collects personal and taxpayer information needed to issue payment and confirm eligibility. The program uses this information for administration, payment, and fraud prevention. It may share limited information with the provider as needed to manage payments and attendance. The provider must keep records and follow confidentiality requirements.

Your approval notice controls. Once processed, you and the provider will receive an authorization that shows the approved schedule, rate unit, and eligible dates. The provider will bill against that authorization. Billing outside those dates or hours may be denied.

How to Fill Out an IL444-3455G – Request for Child Care Provider Change

Follow these steps to complete the form fully and avoid delays.

1) Prepare before you fill it out.

• Talk to the new provider. Confirm they accept the child care assistance program. Confirm their legal name, tax ID, and license or exemption status. Get their provider number if they already have one.
• Choose a firm start date. Coordinate your child’s last day with the old provider and first day with the new provider. Avoid overlap unless the program has approved it.
• Gather your case details. Have your case or family ID, your full name, date of birth, and contact information. Gather each affected child’s full name and date of birth.

2) Complete the parent and case information section.

• Enter your full legal name exactly as it appears on your case.
• Provide your case or family identification number if the form requests it.
• Add your mailing address, phone number, and email. The program will use these to contact you about the change.
• If the form asks for your reason for the change, state it briefly. Examples: moved, provider closed, schedule change, change in provider ownership.

3) List the children who are changing providers.

• Enter each child’s full name and date of birth.
• If the form asks for a child ID, include it. If you do not know it, leave it blank or check your last notice.
• If not all children in your case are moving, state which children are staying with the current provider. This avoids unintended changes.

4) Identify the current (ending) provider.

• Provide the current provider’s legal name and provider number if known.
• Enter the last date your child will attend that provider. This is the end date for payment to the current provider.
• If you had to leave immediately due to closure or safety, explain that in the reason field.

5) Identify the new provider.

• Check the correct provider type. Examples: licensed center, licensed home, license‑exempt center, license‑exempt relative.
• Enter the provider’s legal name and doing‑business‑as name, if any.
• Provide the provider’s tax ID (SSN or FEIN) if the form requests it. This is required for payment.
• Enter the provider’s address, phone number, and email. Use the payment address if different from the site address.
• If the provider is licensed, include the license number and expiration date if requested.
• If the provider is license‑exempt, follow the prompts on the form. You may need to specify the relationship to the child if it is a relative arrangement.

6) Enter the new care start date and schedule.

• Choose a start date that matches your child’s first day at the new provider.
• Enter the regular days and hours of care. Note before‑school, after‑school, and full‑day needs.
• If your child has a different schedule during school breaks, record that in the space for notes or secondary schedule.
• If transportation is provided by the provider, indicate that if the form asks.

7) Record the provider’s rates and the unit of care.

• List the provider’s usual rate for your child’s age group. Use the unit the provider bills (hour, day, or week).
• Confirm that the rate charged for child care assistance is not higher than the private‑pay rate.
• If the provider charges registration or activity fees, note them. The program may not cover all fees. Ask the provider what you may owe.
• If the provider offers discounts or scholarships, do not net them out on the form. List the standard rates and explain discounts in the notes if asked.

8) Acknowledge your co‑pay and payment rules.

• Understand that your monthly co‑pay still applies. You will pay the co‑pay to the new provider each month.
• The program pays the provider directly for eligible care after your co‑pay is applied. You do not receive funds.
• If your income or family size changed, report that separately. The provider change form does not update those details.

9) Complete the provider acknowledgment.

• The provider must read and sign their section. That section confirms they understand program rules, including attendance, billing, and recordkeeping.
• The provider agrees to keep attendance records and to bill only for authorized care. They agree to accept program payments as payment for the covered portion of care.
• If the program requires a tax form or direct deposit form, the provider should submit those as instructed. The change cannot be finalized until payment setup is complete.

10) Sign and date the form.

• You must sign the form. Your signature certifies that all information is true and complete.
• The provider must sign the form. A missing provider signature is a common reason for delays.
• Write the date next to each signature. Use the actual date of signing.

11) Submit the form to your processing office.

• Use the submission method listed on the form. Keep a copy for your records.
• If possible, submit before the start date. That reduces the risk of unpaid days.
• If the provider is new to the program, they must complete any required setup. Ask them to submit their documents promptly.

12) Watch for your authorization and confirm details.

• You and the provider will receive a notice or authorization once approved. Check the start date, schedule, and rate unit.
• If anything is wrong, contact the program office in writing right away. Ask for a corrected authorization.
• Do not assume approval until you receive confirmation. You may be responsible for the care provided before approval.

13) Coordinate the transition.

• Pay any outstanding balance to the old provider, including your co‑pay, up to your last day there.
• Confirm your child’s enrollment date with the new provider. Finish any site‑specific forms they require.
• If your work or school schedule changes during the transition, update the program. Your approved hours depend on your need for care.

14) Avoid common mistakes.

• Do not leave the start date blank. The program needs it to set the authorization.
• Do not estimate rates. Use the provider’s stated rates for your child’s age and care type.
• Do not forget the provider’s tax ID if requested. Payment cannot be issued without it.
• Do not submit without the provider’s signature unless the form allows it. Joint signatures speed processing.
• Do not assume coverage for overlapping days with two providers. Ask before scheduling overlaps.

15) Keep documentation.

• Save copies of the signed form, your submission proof, and your authorization notice.
• Keep your provider’s handbook or agreement. It explains local policies on late pick‑ups, holidays, and closures.
• Keep your work or school schedule and attendance records. The program may request them to confirm your need for care.

Real‑world example: You give two weeks’ notice to your current center. Your child’s last day there is the 15th. You plan to start at the new center on the 18th. You and the new center sign the form on the 5th. You submit it the same day. The program approves the new provider starting the 18th, and the old provider ends on the 15th. You pay your co‑pay to the old center for the first half of the month and to the new center for the second half. Each provider bills only for their authorized days.

Another example: Your provider’s business is sold on the 1st. You submit the form to switch payees effective on the 1st. The new owner submits their payment documents. The program issues authorizations to the new entity. Payment goes to the correct business. There is no gap in care.

If your change is urgent, still submit a complete form. The program can process faster when all fields are accurate and both signatures are present. Incomplete forms often take longer than complete ones submitted a few days later.

Finally, remember that provider approval is not automatic. The state will not pay a provider who fails eligibility checks or documentation. Confirm the provider’s status early. That protects you from unexpected charges.

Legal Terms You Might Encounter

• Case number means the unique number assigned to your child care case. You need it to match your request with your existing benefits. Put it on the form exactly as shown in your notices.
• Eligibility period is the time your case is approved for assistance. Your provider change must fit within this window. If your eligibility is ending soon, your change may only apply until that end date.
• Effective date is the date you want the new provider to start. You enter this date on the form. Payments can only begin on or after the effective date that your office approves.
• Termination date is the date you want the old provider to stop. Use a clear, final date to prevent overlap. This date helps stop billing from the former provider.
• Authorization is the official approval that allows payments to a provider. You receive a notice once the change is processed. The notice will list the provider, children, and dates.
• Provider type describes the kind of provider you choose. It may be a licensed center, a licensed home, or a license-exempt caregiver. The form will ask you to identify the provider type because rules differ.
• Provider identification number is the number used to pay the provider. Some providers use a tax ID, and others use a different assigned number. Provide the number exactly as the provider uses it for payment.
• Family co-payment is the monthly amount you pay. It usually depends on income and family size. A provider change rarely changes your co-payment unless your case details change.
• Retroactive start, also called backdating, means asking to start earlier than today. Your office may limit backdating and require proof of care. Expect that late requests might not be approved.
• Attendance and billing cycle refers to how providers report care dates for payment. Accurate start and stop dates prevent payment delays. Your entries on the form guide those billing reports.

 FAQs

Do you need to submit the form before your child starts at the new provider?

Yes. Submit the form as soon as you know the start date. Payment can begin only after your change is approved. If you wait, you risk unpaid days. Ask the provider to hold billing until you receive approval.

Do you have to tell your old provider you are switching?

Yes. You should give the termination date in writing. Ask the provider to stop billing after that date. Check your agreement for any notice period. Keep a record of your notice.

Does changing providers change your co-payment?

Usually no. Your co-payment is based on your case details, not the provider. It may change if your income, family size, or care schedule changes. If you see a change you did not expect, call your office.

Can you switch providers in the middle of the month?

Yes. You can request a mid-month switch. Payments can be split across providers based on the dates you list. Make sure the dates do not overlap. Confirm each provider reports attendance only for their dates.

Do you need to submit new income proofs when you change providers?

Not in most cases. A provider change does not require a full recertification. You only provide the provider details and the new dates. If your case is due for renewal, the office may ask for more documents.

How long does processing take?

Processing times vary by office and workload. Plan for several business days at a minimum. Submit a clean, complete form to avoid delays. Follow up if you do not receive a notice within a reasonable time.

What if your new provider is still getting approved?

You can submit the change now. Payments cannot be issued until the provider is fully approved. The effective date may start later than requested if approval is pending. Confirm the provider’s approval status before care starts.

What if you entered the wrong start date on the form?

Contact your office right away. Ask how to correct the date. You may need to submit a corrected form. Corrections after payment may take longer and are not always possible.

Checklist: Before, During, and After the IL444-3455G – Request for Child Care Provider Change

Before signing

• Your case number and full contact information.
• Names and dates of birth for each child are changing providers.
• The new provider’s legal name is used for payment.
• The new provider’s address, phone, and payment mailing address.
• The provider identification or tax ID number, if used for payment.
• The provider’s license number if licensed, or relationship if exempt.
• The planned effective date for the new provider.
• The termination date for the old provider, if any.
• Your typical care schedule (days and hours), if the form asks.
• Any required additional documents that your office requested.
• A clear copy of a government ID if your office requires it.
• Access to your prior approval notice to confirm current dates.

During signing

• Verify each child listed is actually switching providers.
• Confirm the effective date is realistic and matches the first day of care.
• Confirm the termination date ends the old provider’s last day of care.
• Check that provider names are spelled exactly as registered for payment.
• Enter all address lines and unit numbers to avoid payment returns.
• Use only legal names, not nicknames, for you and your child.
• Mark the provider type correctly (licensed or license-exempt).
• Fill every field; write “N/A” where it does not apply.
• Sign and date everywhere the form requires a signature and date.
• Review legibility. Rewrite unclear entries before you submit.

After signing

• Make a clear copy for your records before you submit.
• Submit the form using your office’s accepted method.
• Give your new provider your child’s first day and confirm they are ready to bill only after approval.
• Notify your old provider of the termination date in writing.
• Track your submission date and keep any receipts or confirmations.
• Watch for your approval notice and check the dates and provider listed.
• If the notice is wrong, contact your office immediately to fix it.
• Store your copy and the approval notice in one folder for quick access.

Common Mistakes to Avoid

• Listing overlapping dates for old and new providers can cause billing denials. Don’t forget to pick a clean switch date with no overlap.
• Leaving provider identification numbers blank can delay payments. Don’t forget to ask the provider for their payment ID or tax ID.
• Using nicknames or partial names can cause mismatches. Don’t forget to use full legal names for you, your child, and the provider.
• Choosing an effective date before the provider is eligible can create unpaid days. Don’t forget to confirm the new provider meets all requirements.
• Submitting an unreadable or incomplete form leads to processing delays. Don’t forget to print clearly, fill every line, and sign all signature lines.

What to Do After Filling Out the Form

1. Submit the form using the method your office accepts. If you use the mail, allow extra time for delivery. If you use an online or in-person method, request a receipt or confirmation.
2. Tell your new provider the exact start date you put on the form. Ask them to hold billing until the change is approved. Confirm that they use the same dates in their attendance records. This prevents mismatches.
3. Notify your old provider of the final day of care. Share the termination date you wrote on the form. Ask them to bill only through that date. Keep a copy of your notice.
4. Watch for your approval notice. Review the provider name, each child listed, and the effective date. Make sure the termination date for the old provider appears as expected, when applicable. If anything looks off, contact your office right away.
5. Update your child’s drop-off and pick-up arrangements. Share emergency contacts with the new provider. Provide any medical or dietary instructions they need on day one. These steps are separate from the form but critical to a smooth transition.
6. Check your co-payment amount in your next statement. It should match your current case details. If it changes and you did not report other changes, ask your office to review it.
7. If your start date passes and you still have no approval notice, follow up. Provide your case number, child names, and the date you submitted the form. Ask whether anything else is needed to finalize the change.
8. If you need to adjust dates after submission, act fast. The sooner you report a needed correction, the easier it is to fix. You may need to submit an updated form.
9. File your copy of the submitted form and the approval notice. Keep them in your child care records. You may need them if questions come up later about dates or payments.
10. If you decide to change providers again, repeat the process. Use a new form with updated dates and provider information. Submit early to avoid gaps in care or payment.
11. Finally, monitor attendance records for the first month at the new provider. Confirm that days and hours match your approval dates. Quick checks now prevent payment issues later.