Application for
Family Day Care Set-Up
Assistance and Operational
Support Funding
Office Use Only – Service ID number
Office use only
PART A – Service details (all applicants to complete)
1.
Name of your service
2.
Physical address of the service
3.
Name of Director/Coordinator
4.
Contact phone number(s)
5.
Mobile phone number(s)
Operator/Sponsor Organisation
6.
Name of Operator/Sponsor
Organisation
7.
Operator/Sponsor postal address
8.
Name of Manager/contact person
9.
Contact phone number(s)
10. Mobile phone number(s)
11. Email address
Bank account details
12. Account number
BSB (6 digit number)
Account name
13. CCMS – CCB approval ID (if available)
14. Australian Business Number (ABN)
15. Does your FDC service operate any other type of child care/family services from the same
location?
No
Yes
If Yes. What type of service(s)
Long Day Care
Outside School Hours Care
Occasional Care
In Home Care
Other, please specify
PART B – Eligibility (all applicants to complete)
Your answers to the questions in this section will determine your FDC service’s eligibility for Set-up
Assistance and Operational Support funding.
16.
Is your FDC service approved to receive the Child Care Benefit (CCB) on behalf of families?
No
Have NOT applied for CCB approval
No
Have applied for CCB approval
Yes
Go to Question 19
17.
Is your FDC service approved with the relevant state or territory Regulatory Authority?
No
When do you expect to receive your Service Approval?
Yes
Please attach copy of Service Approval.
PART C – Set Up Assistance (all applicants for Set Up Assistance only to complete)
18. Is your service not-for-profit?
Not for profit means all income received from the provision of child care services, including all
funding from the Australian Government, is expended in the provision of child care.
No
> If ‘No’, does the service operator operate 10 or more services? No
Yes
Yes
19. Is your FDC service operated by an incorporated body?
No
Yes
20. Is your FDC service taking over from an existing FDC service?
No
Yes
21. Has your FDC service split from an existing service?
No
Yes
22. Is your FDC service relocating an existing service?
No
Yes
23. Is your FDC service (or will it be) co-located with another service? No
Yes
24. Please attach documentation that demonstrates that there is an unmet demand for child care
in the areas in which your service proposes to operate. The information you provide may
include:

A demonstrated understanding of who and where the child care services are that
already service the area;

Information from local child care-related organisations that may have an
understanding of unmet demand;

Waiting lists for your service or other existing child care services;

Letters from relevant parties indicating a shortage of Family Day Care in the area;
and

Demographic data that demonstrates demand in the area is increasing beyond the
capacity or has already increased beyond the capacity of existing child care services
to service.
PART D – Applicant declaration (all applicants to complete)
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I declare that the information given in this application is complete and correct;
I declare that I have reviewed and understood the CSP Funding Agreement – April 2014 and CSP
Programme Guidelines – April 2014;
I authorise the department to verify any information provided in this application;
I am authorised to act on behalf of the applicant;
I understand that eligibility for Set-up Assistance and Operational Support funding is conditional on the
provision of true and correct answers on this form; and
I understand that eligibility and payment of Set-up Assistance and/or Operational Support Funding is
conditional on compliance with the following:
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A New Tax System (Family Assistance)(Administration) Act 1999, and A New Tax System (Family
Assistance) Act 1999, and related disallowable instruments as relevant to the Funding Recipient;
State/territory and local government laws, regulations and licensing requirements;
All other relevant laws (for example, association or corporate law, state or territory licensing laws
where applicable, police checks);
The relevant CSP Funding Agreement – April 2014 as issued by the Department;
The relevant CSP Programme Guidelines – April 2014 as issued by the Department;
The relevant Child Care Services Handbook as amended from time to time, as issued by the
Department;
Any other documents as reasonably requested by the department; and
Participation in and co-operation with compliance visits as requested by the department.
Signature of authorised officer
Date
Name (please print)
Position
NOTE: Giving false or misleading information is a serious offence
Returning the application
Applications should be submitted to the Department of Education office in your State or Territory.
For contact details go to the Department’s website at www.education.gov.au
For assistance please call the Department of Education on 1300 363 079 and ask to speak to a child care officer in your State
or Territory.
Office use only – Please use red pen
I am authorised to sign on behalf of the Department
Printed name
Date
dd/mm/yyyy