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 anything is incorrect and should not be submitted to the Tennessee Department of Human Services, click the "Reject" button to reject this EAV. Or, you can click the "Previous" button if you want to make changes to this EAV if it is incorrect. If you are ready to submit this EAV, click the "Submit" button.

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

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