National Childcare Investment Programme Operational Grants Scheme

NCIP Community Childcare Subvention Scheme (2008-2010)

The above scheme subvents community not-for-profit childcare services, to provide assistance with the cost of childcare fees for parents who qualify under the schemes listed below. You are asked to complete this form and return it to your childcare service. The information will be forwarded, in confidence, to the Office of the Minister for Children (OMC) for validation.

Declaration by the Parent

Your Name: ______PPS No.

BLOCK LETTERS

Name of Childcare facility: ______

I state that I am the parent or legal guardian of the following child/ren who attend this childcare facility.

I am getting one (or more) of the following payments

Band A

One-Parent Family Payment

Widow’s or Widower’s Pension

Jobseeker’s Benefit or Allowance (Was

Unemployment Benefit or Assistance)

Pre-Retirement Allowance

Farm Assist

State Pension (Was Old Age or Retirement Pension)

Blind Pension

Guardian’s Payment (Was Orphan’s Pension)

Illness or Injury Benefit

Disablement Benefit

Invalidity Pension

Disability Allowance

Carer’s Benefit or Allowance

Back to Work /Education Allowance

Supplementary Welfare Allowance

I am getting one (or more) of the following payments

Band B

Family Income Supplement Part-time Job Incentive Scheme

FÁS Training Allowance

If you are on a Government training or work experience programme (Community Employment Scheme, for example) or attend secondary school, please state the name of the programme, or the name of the school: ______

If you are a medical card holder, or the holder of a GP Visit Card, please tick the appropriate box below:

Medical CardGP Visit Card

I agree that the information given on this form may be used for the following purposes: by the childcare service to reduce the rate of fees charged to me for that service; by the Office of the Minister for Children to calculate the subvention due to the childcare provider and for statistical and control purposes, in conjunction with the relevant Government Department and/or FÁS. If the information given above changes, I will tell my childcare provider immediately.

Your Signature ______Date: ______

I confirm that the child/ren listed above attend (s) childcare service. I will not use the information given for any purpose except as provided for above. I will not keep the details supplied except to note the discount due to the parent.

Signature of Manager/Leader/Supervisor: ______Date: ______