Parent/Guardian Child Care Allowance Program Expense Form

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Personal information on this form is collected under the Provincial Health Number Act R.S.P.E.I. 1988, Cap.P-27.01 and section 31 of the Freedom of Information and Protection of Privacy Act R.S.P.E.I. 1988, Cap. F-15.01, and will be used for the purpose of administering payments to the individuals or suppliers that are identified on this form. This use includes the sharing of this information within the Government of Prince Edward Island and its agencies to update and ensure accuracy of information for administering payments. Questions on the collection and use of this information can be directed to the manager of Administration at 902-368-5230.

Identification

To be completed by the same person named on the initial child care allowance application.

First Name

Middle Initial

Last Name

Address 1

Address 2

City, Town, or Community

Province

Postal Code

For example C1B 0X1 or 12345

Country

Telephone Number

For example 902-555-5555

Email Address

Personal Health Number (PHN)

Please enter the 8-digits from your PEI health card.

Child Care Allowance Submission Number

Provided upon acceptance to the Child Care Allowance program.