The Missouri DC 20 form is a questionnaire used by the Missouri Department of Health and Senior Services to evaluate the regulatory status of children's programs. This form helps ensure that programs meet necessary standards for operation and provides essential information about their management and services. If you are involved in a children's program, consider filling out the form by clicking the button below.
The Missouri DC 20 form serves as a vital tool for evaluating the regulatory status of children's programs within the state. This comprehensive questionnaire is designed to gather essential information about the operation and management of child care services. When completing the form, applicants must provide a detailed description of their programs, including any pamphlets or parent policies that outline operational guidelines. Additionally, organizations must submit documentation proving their affiliation with recognized national or regional entities, particularly for those claiming a religious exemption under federal tax laws. The form also requires an organizational chart that clarifies the administrative structure and lines of authority for the program. Furthermore, it prompts applicants to specify operational details, such as the age range of children served, the number of operating months, and the hours of operation. Importantly, the form asks for information about funding sources and any other child care programs managed by the same owner or organization. This ensures that all relevant details are captured, promoting transparency and accountability in child care services across Missouri.
Missouri Department of Health and Senior Services Section for Child Care Regulation
Program Evaluation Questionnaire
OFFICE USE ONLY
DVN
INSTRUCTIONS
To determine the regulatory status for children’s programs, the following documents must be submitted with this completed questionnaire:
1.Description of each program(s) or pamphlet describing the program(s).
2.Parent policies, handbook, registration or enrollment form (if available).
3.Documentation from a national or regional Title 36, Public Law 105-225, organization that the organization is affiliated in good standing.
4.For Religious Organizations – A federal tax exemption letter as required by section 501(c)(3) of the Internal Revenue Code of 1954, or any amendment thereto; or documentation that the real estate on which the facility is located is exempt from taxation because it is used for religious purposes or copy of letter of exemption from Missouri sales and use tax on purchases and sales; or documentation that the real estate on which the facility is located is exempt from taxation because it is used for religious purposes; and
Organization chart – This chart must show the structure of the administrative lines of authority between the children’s program(s) and the individual or organization that owns/operates the program(s).
IDENTIFYING INFORMATION (Additional sheets may be attached for each program.)
Name of program
Location of program (street, city, state, zip code)
Mailing address (If different from above.)
County
Telephone number of program (
)
ADMINISTRATION
Organization (or individual) legally responsible for operation and management of the program(s)
Address
Telephone number (
Contact person (name and title)
Email Address
DC-20 (9-08)
PROGRAM(S)
Is this program currently in operation?
Yes
No
If no, please show target opening date _____________ and answer the following questions regarding your
proposed plan.
Number of children
Age range
From
To
Months of operation: (Check any that apply.)
All 12 months
January
February
March
April
May
June
July
August
September
October
November
December
Hours of operation for each program: From
a.m./p.m. to
a.m./p.m.
Maximum number of hours a child may attend each day.
Number of employees’ children enrolled in the program.
Explain how you are compensated for providing your service, this can include any type of funding received?
Does this owner or organization operate any other child care program?
If yes, name and address of program:
Does this program receive any direct state or federal funds?
If yes, list any agencies from which you receive funds:
Explain what type of activities your program will offer (educational, recreational, childcare, etc.)
SIGNATURES
The undersigned is responsible for the information on this form and affirms that the information is true and accurate. (If the administrator and director are different, the signatures of both individuals are required.)
Name and title of the director of the program (Please print.)
Signature of director of the program
Date
Name and title of the administrator of the organization (Please print.)
Signature of administrator
State of Missouri Business Search - It is part of the broader process of liquidating a business, allowing for an orderly cessation of operations.
A Prenuptial Agreement is a legal document created by two individuals before they enter into marriage, outlining the division of assets and responsibilities should the marriage end. In Arizona, this agreement serves to protect the interests of both parties, providing clarity and peace of mind. Understanding the nuances of the Arizona Prenuptial Agreement form can help couples navigate their financial futures together, and resources such as Arizona PDFs can be invaluable in this process.
State of Missouri Forms - A vital tool for individuals required to prove they have no disqualifying criminal history for certain roles or permissions.