W-9 Request for Taxpayer Identification Number and Certification 400-28-105-50

(Revised 6/1/22 ML #3669)

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A "W-9,” Request for Taxpayer Identification Number and Certification" is required from a provider upon initial acceptance of a CCAP household. CCAP will not make payment to providers before a W-9 is on file. W-9s must be submitted at each license renewal. A W-9 is required before license renewal when the following occurs:

• Change in name
• Change in provider type (family to group, group to center, et cetera)
• Change in address
• Change in either Social Security Number (SSN) or Employee Identification Number (EIN) when either is being used as the Taxpayer Identification (TIN)

The W-9’s should be completed and mailed to:

Child Care Assistance Program

ND Department of Human Services – Dept. 325

600 E Boulevard Ave

Bismarck, ND 58505-0250

A W-9 can also be emailed to dhseap@nd.gov or submitted electronically through the provider’s self-service portal.