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NRSA Childcare Costs Payment Request Form

Recipients (Fellows & Trainees): Complete the form fields below and upload required attachments for confirmation of costs and proof of licensure of the childcare provider. Be sure to check the accuracy of the email(s) entered for your department administrator(s) as the form will route to those individuals for processing.

Department Administrator: Upon receipt of completed request forms, process graduate student payments via GradStar and postdoctoral fellow payments via Payroll. Please reference the Process Overview to assist with reviewing and approving payments.
  • Graduate Student Account is 568720 (Traineeship Dependent Allow)
  • Postdoctoral Fellow Account is 517150 (Postdoc Dependent Allow)

Recipient & Award Details

Recipient Name:(Required)
UNC personal identification number (7xxxxxxxx)
UNC ConnectCarolina project ID (5xxxxxx)
Enter the complete sponsored issued award number

Payment Request & Performance Period

Payment Request Type(Required)
  • Fellows: enter the budget start date of the award year you are requesting payment
  • Trainees: enter your appointment start date of the award year you are requesting payment
MM slash DD slash YYYY
  • Fellows: enter the budget end date of the award year you are requesting payment
  • Trainees: enter your appointment end date of the award year you are requesting payment
MM slash DD slash YYYY
Enter a requested payment amount for the childcare stipend that is less than or up to your full $2,500 allowance for the annual/budget period (performance dates listed above).
Please enter a number from 0 to 2500.

Required Documentation to Upload

Please reference Documentation Overview for more details.
Acceptable forms of documentation may include an invoice, payment receipt, or an agreement/letter from the provider. Be sure to upload any combination of documentation as needed so that all the criteria listed below are included:

  • Full name(s) of eligible children listed on the invoice, receipt, and/or agreement
  • Name of the childcare provider
  • Dates of service
  • Amount/cost of childcare
Drop files here or
Max. file size: 98 MB.
    Acceptable forms of documentation may include:
    • NCDHHS Childcare Facility Search Form – Download or print to PDF, the report of the childcare provider licensure information obtained from the web search. NOTE: if the report identifies current administrative actions taken against the facility, the cost is not allowable and an alternate provider would be needed in order to qualify for the stipend
    • Agreement between childcare provider and recipient providing the state licensure number
    • Copy of the licensure certification provided to the childcare provider
    • For out of state childcare providers – search for licensure info on https://childcare.gov/home
    Drop files here or
    Max. file size: 98 MB.

      Department Administrator Routing

      If entering multiple emails, separate each email with a comma. For example: john_doe@unc.edu, jane_doe@unc.edu

      Certifications

      Recipient Attestation on Retention of Documentation(Required)
      Recipient Certification of Eligibility and Compliance(Required)

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