Conference Registration

Please select your role at this event.

Role*

--------- Federal Employee State CCDF Administrator Territory CCDF Administrator State CCDF Staff Member Territory CCDF Staff Member OCC National TA Center Staff National Organization Invited Presenter or Guest Other

Sub Role

--------- Child Care Automated Reporting System (CARS) Child Care Meeting Management Center (CMC) Child Care State Capacity Building Center (SCBC) Data and Information Systems Consultation Center (DISCC) National Center on Afterschool and Summer Enrichment (NCASE) National Center on Early Childhood Quality Assurance (NCECQA) National Center on Subsidy Innovation and Accountability (NCSIA) National Early Care and Education Workforce Center (ECE Workforce Center) National TA Center for Preschool Development Grants Birth through Five (PDG B-5 Center) Tribal Child Care Capacity Building Center (TCBC) Other

Other Role

Other Sub Role

Contact Information

First Name*

Last Name*

Prefix

--------- Dr. Mr. Mrs. Ms.

Title/Position*

Division/Office*

Organization*

City*

State*

--------- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming American Samoa Guam Northern Mariana Islands Puerto Rico Virgin Islands

Zip code*

Phone number*

Email*

Emergency contact name

Emergency contact phone number

Emergency contact email

OCC Region*

--------- Region 1 (CT, ME, MA, NH, RI, VT) Region 2 (NJ, NY, PR, VI) Region 3 (DE, DC, MD, PA, VA, WV) Region 4 (AL, FL, GA, KY, MS, NC, SC, TN) Region 5 (IL, IN, MI, MN, OH, WI) Region 6 (AR, LA, NM, OK, TX) Region 7 (IA, KS, MO, NE) Region 8 (CO, MT, ND, SD, UT, WY) Region 9 (AS, AZ, CA, GU, HI, MP, NV) Region 10 (AK, ID, OR, WA) NA

Additional Information

If you are new to your role, would you participate in an opportunity to learn about the Fundamentals of CCDF Administration during STAM?

---- Yes No N/A

Do you require any special accommodations?

---- Yes No

Please specify

0

Do You Require Any Translation Services? Requieres algun servicio de traducción?

---- Yes/Sí No

Please specify/Por favor especifica

0

How will you attend?*

---- In-Person Virtually (Please note that virtual options will be limited) A combination of both

Will you be staying at the hotel?

---- Yes No

Please note – your response to the next two questions will not be anonymous and may be used to develop peer-to-peer discussion groups.

Please select topics that you would be willing to discuss with your colleagues about successes in implementing CCDF priorities, including those in the early stages. You may select more than one topic.

Payment rates and co-payments Grants and contracts Prospective payments Paying by enrollment Presumptive eligibility 12 month eligibility Consumer education Data and IT Systems Other

Other

0

Please select the topics below that you have questions about and would like to discuss with your colleagues. You may select more than one topic.

Payment rates and co-payments Grants and contracts Prospective payments Paying by enrollment Presumptive eligibility 12 month eligibility Consumer education Data and IT Systems Other

Other

0

PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN: The purpose of this information collection is to collect registration information from potential participants in OCC’s State and Territory CCDF Administrator’s Meeting to allow organizers to compile proper resources and tools for participants. Public reporting burden for this collection of information is estimated to average 5 minutes per grantee, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. This collection of information is voluntary. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information subject to the requirements of the Paperwork Reduction Act of 1995, unless it displays a currently valid OMB control number. The OMB # is 0970-0617 and the expiration date is 09/30/2026. If you have any comments on this collection of information, please contact stacy.cassell@acf.hhs.gov