Government of Guyana
Ministry of Human Services and Social Security
Application for Child Care Subsidy for Essential Workers
PLEASE COMPLETE ALL SECTIONS WHERE APPLICABLE
Applicant Information
First Name
Last Name
Date of Birth
-
Year
-
Month
Day
Date
National Insurance Scheme Number
National ID or Passport Number
Citizen Status
Guyanese National
Regularised Migrant
Sex
Male
Female
Address (include Apt. number, Street, Neighbourhood)
Lot/Apt number
Street
City/Town
Region
Postal / Zip Code
Cell Phone Number
Please enter a valid phone number.
Landline Phone Number
Please enter a valid phone number.
Email Address
example@example.com
Reason for Care (Check as many as possible)
Working
Attending School/Study Time Needed
Free Time needed to psychologically recharge
Time needed to physically rest
Time needed with my spouse/partner
Any other (please specify in space below)
Please specify your reasons here
Places of Work/School (if applicable)
Contact Number for Work/School
Please enter a valid phone number.
CO-APPLICANT’S INFORMATION
Please bear in mind that the co-applicant is the parent/co-guardian of the 1 child age 7 or below that will benefit from the child care subsidy programme.
I am a single parent/I am the sole legal guardian of this child
*
Yes
No
Co-Applicant's Information
First Name
Last Name
Date of Birth
-
Year
-
Month
Day
Date
National Insurance Scheme Number
National ID or Passport Number
SEX
Male
Female
Citizen Status
Guyanese National
Regularised Migrant
Irregular Migrant
Address (include Apt. number, Street, Neighbourhood)
Lot/Apt number
Street
City/Town
Region
Postal / Zip Code
Primary Phone Number
Please enter a valid phone number.
Secondary Phone Number
Please enter a valid phone number.
Email Address
example@example.com
Reason for Care (Check as many as possible)
Working
Attending School/Study Time Needed
Free Time needed to psychologically recharge
Time needed to physically rest
Time needed with my spouse/partner
Any other (please specify in space below)
Please specify your reasons here
Places of Work and designation/School (if applicable)
Contact Number for Work/School
Please enter a valid phone number.
CHILDREN’S DETAILS
Include children (under the age of 18 years) of the applicant who live in the same home and who are financially dependent on the applicant. Also include dependents who may be 18 years and older who are disabled or who attend high school/university and are financially dependent
Please specify the details of the number of children living with the applicant
Total number of female children
Total number of male children
Number of children in school
Number of Children with disabilities
Total Number of Children
Children ages
0 - 7
Children ages
8 - 12
Children ages
13 - 17
Children ages
18 +
Please specify the details of the number of children under the custody of the applicant
Number of female children
Number of male children
Number of children in school
Number of children with disabilities
Total Number of Children
Children ages
0 - 7
Children ages
8 - 12
Children ages
13 - 17
Children ages
18 +
LIST CHILDREN REQUIRING CHILD CARE SUBSIDY
Please bear in mind that for the first phase of this programme, ONLY 1 CHILD PER HOUSEHOLD OF AGE 7 OR UNDER QUALIFIES but the Ministry of Human Services and Social Security inquiries about the number of children that may need day care per household or essential worker to improve what we do and create better implemented programmes in the future.
Child's Information
First Name
Last Name
Date of Birth
-
Year
-
Month
Day
Date
Grade (if applicable)
Name of Licensed Child Care Centre
Address of Licensed Child Care Centre
Lot/Apt number
Street
City/Town
Region
Postal / Zip Code
Does the Child have any disability?
Yes
No
If yes, please specify
Estimated hours of care needed per month
Estimated costs in day care fees (per term)
Please indicate the needs for child care services by days and shifts
8am - 4pm Shift
4pm - midnight shift
12 midnight - 8am shift
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Total number of hours
If there was night care available in the city, would you use these services?
Yes
No
Where would you prefer the location of the night care to be?
Near Home
Near to Work
It does not matter to me
Please specify your needs. Please tick as many options applicable to your circumstances
Evening work shifts
Study Time
Complete chores
Run errands
Sleep/rest
Any other (please specify below)
Please specify any other need below
Please attach to this form the following documents.
Applicant
Copy of ID card
Birth certificate for child of age 7 or under
Job letter with salary
Pay slip
Invoice of licensed day care
Please upload files here
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of
I, the applicant, I am a single parent/I am the sole legal guardian of this child. Therefore, the below documents and signature are not required to be submitted.
Please attach to this form the following documents.
Co- Applicant
Copy of ID card / Passport
Job letter with salary
Pay slip
Please upload files here
Browse Files
Drag and drop files here
Choose a file
Cancel
of
APPLICANT DECLARATION AND ACKNOWLEDGEMENT. I understand that giving false or incomplete information or not advising of any changes in circumstances may result in termination or suspension of funding and the requirement to repay funding that I have received.
I understand that the information I give on the application form may be verified by a Human Services and Social Security Ministry representative at any time.
I will advise Child Care Subsidy Program for Essential Workers immediately of any changes in personal, financial, or family circumstances that will affect my eligibility for subsidy.
I understand that I may be required to provide additional information in order to confirm any initial and continuing eligibility for Child Care Subsidy. I understand that Children's Services may initiate an investigation relating to my eligibility for Child Care Subsidy.
I understand that relevant personal information may be shared with a licensed child care program, approved early learning program, or family day home agency that I have chosen for the care of my child, including information to identify myself/ourselves, my/our child(ren), our address, the amount of subsidy we are eligible to receive and the subsidy period.
I understand that relevant personal information may be shared with other Government programs and services including my/our financial information, employment information, marital status, telephone numbers, dependents addresses and the amount of subsidy to verify/determine my/our eligibility for other government programs or benefits offered by the Government of Guyana.
I/We consent to the release, by Guyana Revenue Authority to an official of the Ministry of Human Services and Social Security of income and expense information and identifying information about me/us and our children or dependents, including any social insurance number(s) from GRA records about me/us. The information will be relevant to, and will be used for the purpose of determining, verifying and/or auditing my/our eligibility for the subsidy and collection of overpayments of subsidy provided for in the Child Care Subsidy Program.
In addition, I/we consent to the disclosure by an official of the Ministry of Human Services and Social Security to a licensed child care program that I/we have chosen for the care of my/our child, of information obtained from the Guyana Revenue Authority in accordance with this consent or obtainedfrom other sources, that identifies myself/ourselves, my/our child(ren), our address, the amount of subsidy we are eligible to receive under the Child Care Subsidy Program, together with the subsidy period
Finally, I/we consent to the disclosure by an official of the Ministry of Human Services and Social Security an official of a department or agency of the Government of Guyana, of information obtained from the Guyana Revenue Authority in accordance with this consent or from other sources, that identifies myself/ourselves, my/our child(ren), our address, our marital status, my/our income and expenses and the amount of subsidy we are eligible to receive under the Child Care Subsidy Program
I declare that I understand the above information on this application and provide my signature as consent
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