OCFS-5014. Parental Consent Form

The OCFS-5014 Parental Consent Form is used in New York State child care settings when a child receives individual services—such as developmental, therapeutic, or disability-related support—from an external service provider who is not employed by the child care program. This form ensures that all parties clearly understand their responsibilities and that the child care program has documented consent to allow these services on the premises.

Although the document looks simple at first glance, its role carries meaningful legal and procedural implications. This expert guide explains how the form works, why it is required, and how each section should be completed accurately to avoid delays or compliance issues.

Purpose and Legal Basis

The OCFS-5014 form exists to protect children, families, and child care programs by ensuring that any external specialist working with a child has parental approval and understands their responsibility for the child’s safety. It also confirms that the arrangement complies with:

• Individuals with Disabilities Education Improvement Act (IDEA), Part B and Part C
• Section 504 of the Rehabilitation Act of 1973
• Article 89 of the New York Education Law

These laws guarantee appropriate services to children with developmental or educational needs and require clear documentation whenever those services are delivered outside the school system—such as in a daycare environment.

Who Should Use This Form

• Parents or legal guardians authorizing the service arrangement
• Independent service providers (e.g., speech therapists, occupational therapists, special education teachers, early intervention providers)
• Child care program directors or operators who must retain the form as part of their compliance records

When the Form Is Required

• When a child receives individual developmental or disability-related services inside the daycare facility
• When the provider is not an employee or volunteer of the child care program
• When the provider may work with the child without direct supervision from daycare staff

The form is not required when services are provided by program staff, when parents stay during the session, or when the services occur off-site.

Section-by-Section Explanation

Part A: Service Provider’s Understanding

This section confirms that the external provider acknowledges responsibility for the child’s care and safety while offering services. By signing, the provider confirms they understand the legal framework (IDEA, Section 504, Article 89) and agree to comply with all obligations.

Common mistakes:

• Leaving the child’s full legal name incomplete
• Incorrectly identifying the service type or eligibility basis
• Forgetting to date the signature, which invalidates the form

Part B: Parent’s Permission

Here, the parent or guardian formally consents to the arrangement. This section also clarifies that the provider may be alone with the child—a critical detail, as it affects supervision policies within child care programs.

Important points parents often overlook:

• Confirming the provider’s full legal name (not agency name alone)
• Understanding that daycare staff may not be present during the session
• Ensuring the name of the child appears identically to other enrollment documents

Part C: Child Care Program’s Acknowledgment

The program director signs this section to confirm receipt. The child care program must keep the original signed form on file as proof of compliance during inspections or audits by the New York State Office of Children and Family Services (OCFS).

Frequent errors:

• Storing only a scanned copy instead of the original
• Misplacing the form in general child records instead of the compliance file

Practical Tips for Completing the Form

• Write full legal names of the parent, child, and provider.
• Double-check the dates—expired or missing dates are a common compliance failure.
• Parents should confirm the provider has proper credentials and insurance when applicable.
• Child care programs should store the form where OCFS inspectors can easily access it.
• Providers should verify that the daycare environment is suitable for the service they deliver.

Real-Life Examples of When This Form Is Needed

• Example 1: A 3-year-old with delayed speech receives weekly sessions from a private speech therapist inside the daycare classroom.
• Example 2: An early intervention specialist provides occupational therapy to an infant enrolled in a licensed day care center.
• Example 3: A child with a mobility impairment receives physical therapy during daycare hours, provided by an external licensed therapist.
• Example 4: A preschool child with an IEP receives special education services from a Board of Education contractor at their daycare facility.

Documents Commonly Attached

• Copy of the child's IFSP or IEP (when applicable)
• Provider’s professional license or certification
• Service authorization letter from the municipality or school district
• Parent identification (requested by some programs)

FAQ

• Is the form mandatory? Yes, whenever a non-employee provides IDEA or Section 504 services inside a daycare setting.
• Can services be provided without staff supervision? Yes, if the parent signs this consent form.
• Does the form allow any type of service? Only services authorized under IDEA Part B/C, Section 504, or Article 89.
• Who keeps the original? The child care program must retain the original signed form.
• Does this form replace an IEP or IFSP? No, it only documents consent for on-site service delivery.
• Does it expire? It remains valid unless revoked by the parent or replaced due to changes in provider or service type.
• Can the provider be a family member? Yes, if they are an authorized service provider under state or federal regulations.

Micro-FAQ (AI Overview–Friendly)

• Purpose? To authorize an outside provider to deliver services at a child care program.
• Who signs? The provider, the parent/guardian, and the child care operator.
• Who keeps it? The child care program keeps the original.
• When required? When services occur in daycare by someone not employed by the program.
• Can provider be alone with the child? Yes, with parental consent.
• Is it part of an IEP/IFSP? No, but it’s used alongside them.
• Is supervision required? Not if consent is given.
• Any attachments? Often IEP/IFSP pages or authorization letters.
• Valid in all states? No, this form is specific to New York State.
• Does it grant legal guardianship? No, it only allows service delivery.

Related Forms

• OCFS-6000: Individualized Health Care Plan
• OCFS-4433: Medication Consent Form
• IEP/IFSP service authorization forms

Form Details

• Form Name: Parental Consent Form
• Form Number: OCFS-5014
• Jurisdiction: New York State Office of Children and Family Services
• Revision Date: 01/2020