General Services Administration (GSA) Child Care Subsidy (CCS) Program Forms Library
This library contains forms used in support of Family application or enrollment changes for the GSA Child Care Subsidy Program.
Employees who are applying for a GSA Child Care Subsidy Benefit for the first time and those who were previously enrolled, but not currently participating in the program please visit Child Care Subsidy Program for a complete enrollment package.
Forms & Packages for Current Participants:
- Annual Recertification: Each Employee participating in the GSA CCS Program must complete the Annual Recertification process each year in order to determine their continued eligibility. Please visit Annual Recertification Process for a complete Recertification packet.
- Authorization for Release of Information [PDF - 29.58 KB]: Used to provide a school, employer, or medical facility with authorization to release information to the GSA in order to support an application for the GSA CCS Program.
- Certification to Add Child/Children Package [PDF - 116.62 KB]: Used by Employees currently participating in the GSA CCS Program to add one or more children.
- Certification of Custody Form [PDF - 129.59 KB]: Used when a legal Custody Agreement has not been filed with courts.
- Certification of Higher Education [PDF - 41.02 KB]: To be used when a Spouse/Partner is enrolled in school. When properly completed, this form will ensure that the GSA has all required information in conjunction with the school schedule.
- Certification for Seeking Employment and/or Enroll in School [PDF - 171.89 KB]: Allows Temporary Authorization to receive GSA CCS while the Spouse/Partner seeks employment or enrolls in school.
- Certification of Self Employment [PDF - 133.91 KB]: Must be completed when Employee, Spouse, or Partner is self-employed.
- Certification of Withdraw from Program [PDF - 76.97 KB] Used when an Employee/Family wishes to be officially removed from the program or is removing a child or children from the current provider.
- Change in Personal Situation Package [PDF - 358.30 KB]: Used by Employee’s who have a change in the personal situation to include Marriage, Divorce, and Separation from their Spouse or Partner or in situations where a Partner has moved into the home or out of the home.
- Employee/Family Update Form [PDF - 62.15 KB]: Used to update Address, Phone, Email, Family Status, and/or custody of child.
- Family Enrollment Provider Cost Verification Form [PDF - 61.15 KB]: Used to verify rates, attendance, and enrollment dates. Must be completed and signed by the provider.
- Notification of Maternity Leave [PDF - 31.65 KB]: Used to inform the GSA when an Employee, Spouse, or Partner will be out of work due to maternity leave.
- Provider Change Request Package GSA [PDF - 221.82 KB]: Used by Employees currently participating in the GSA CCS Program to change providers.
- Request for Benefit to be Placed in an Inactive Status [PDF - 117.66 KB]: Allows an Employee to remain in the program for up to 90 days while not actively receiving benefits.
- Request to Reactivate Child Care Subsidy Benefits Package [PDF - 105.38 KB]:To be used when an Employee/Family's benefit has been placed in an Inactive Status and the Employee/Family is requesting a Reactivation of benefits.
- Separation Verification Form [PDF - 131.47 KB]: Used to support eligibility when a legal document has not been issued by the courts.