Report Childcare Attendance Online

Verify Before Release

Online Demonstration

05/01/2014 - 05/31/2014 EAV BACKDATED

For Care Provider:
ABC Childcare, 123456789, 123 1111 Main St., Suite 111, Nashville, TN 37219

Please verify all of the information is correct for this EAV. If you need to make a change, click the "Previous" button. If you are ready to release this EAV to the Authorizer, click the "Release" button. Please be aware that the Authorizer can reject this EAV. Please check the "Main Menu" page periodically after submitting this EAV.

Child Name SSN 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Sample, Kate A xxx-xx-1111 5 1 2 8 8     8 8 8 8 A     8 4 4 8 8     H 4 4 4 4     A A C
Test, Jimmy J xxx-xx-2222 4 7 8 8 8     5 8 8 8 8     8 8 8 8 8     5 5 8 5 8     8 8 C
Test, Joey A xxx-xx-3333 4 7 8 8 8     5 8 8 8 8     8 8 8 8 8     8 8 8 8 8     A 8 C

Children Added This EAV Period

Child Name SSN 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Demo, Jane M xxx-xx-4444 5 1 2 8 8     8 8 8 8 A     8 4 4                            

Additional Comments

(Include notes or comments about child absences or exceptions to schedules if necessary). Insert additional comments here if added.


Accidental or intentional misrepresentation of the hours or codes on an EAV invoice form can result in the taking back of payments and possible prosecution for fraud.

Online Demonstration

Exit Demo