Release Statement: I, the undersigned, hereby agree that the information provided in this enrollment form is complete, accurate and will be entered into the Maine Department of Health and Human Services (DHHS) Child Care Affordability online invoicing database. I understand that I am responsible for information included in this application. I understand that I am responsible for the individual(s) who access the Maine Department of Health and Human Services (DHHS) Child Care Affordability online invoicing database. I understand that DHHS is a public entity and will protect the confidentiality of personal information provided to the extent permitted under state and federal law.
I understand that the information in my file will be used by relevant State agencies and programs to verify provider status and billing information.