I declare that the information I have given on this application is true and complete.
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 representative at any time.
I will advise Human Services Child Care Subsidy program 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 my initial and continuing eligibility for Child Care Subsidy. I understand that Human Services may initiate an investigation relating to my eligibility for Child Care Subsidy.
I consent to:
Human Services staff disclosing to a licensed child care program, approved early learning program or family day home and agency that I have chosen for the care of my child, information to identify myself/ourselves, my child(ren), our address, the amount of subsidy we are eligible to receive and the subsidy period.
Human Services disclosing to other Ministries in the Government of Alberta and the Government of Canada the following information about myself/ourselves including: financial information, employment information, marital status, telephone numbers, dependents and addresses and the amount of subsidy to verify/determine my/our eligibility for other government programs or benefits offered by the Government of Alberta or the Government of Canada.
I/We consent to the release, by Canada Revenue Agency to an official of the Ministry of Human Services of income and expense information and identifying information about me/us and our children or dependents, including any social insurance number(s) from CRA 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 to a licensed child care program, approved early learning program of contracted family day home agency that I/we have chosen for the care of my/our child, of information obtained from the Canada Revenue Agency in accordance with this consent or obtained from 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 to an official of a department or agency of the Government of Albert, of information obtained from the Canada Revenue Agency 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. This information may be used for the purpose of determining, auditing and verifying my/our eligibility for any income tested benefit under an Alberta income support program for which I/we may apply in the future, and for collecting any overpayment of the benefit, provided I/we did apply for the income tested benefit.
This consent is valid for the taxation year prior to the year of signature, the current taxation year and for each subsequent taxation year in which a subsidy or benefit is requested.
I have read the above Declaration and consent and I understand what it says.