Try for free

California CCD 27 Statement of Parental Incapacity

Subsidized child care in California can be based on a parent's physical or mental incapacity, which state law requires to be verified at least once a year. On the CCD 27 a legally qualified health professional confirms the parent's condition prevents them from caring for or supervising their children for at least part of the day, and sets out the hours and days care is needed.

Who completes it

A legally qualified health professional treating the parent completes and signs Part II with their license number. Part I is completed by the child care agency's authorized representative and the parent, who signs the release.

Submitting and payment

How to submit it
Sign and send the form to the child care agency listed in Part I, such as the Alternative Payment Program or contractor handling the family's case.
Who pays
The form sets no fee and does not say who pays for completing it.

Good to know

  • Verification is required at least annually under Welfare and Institutions Code section 10271 when incapacity is the basis of need for child care.
  • The schedule grid asks for start and end times for each day of the week, and the total may not exceed 50 hours a week.
  • By signing Part I the parent lets the agency discuss the statement with the health professional to verify, clarify or complete it.
  • The form notes that the health professional may require the parent to sign the practice's own release first.

Get the official form

Download the current version from the source each time; forms change without notice.

Statement of Parental Incapacity

Official pagePDF

How this list is checked

A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.

Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.

Frequently asked questions

How often is the CCD 27 required?

At least once a year. Part II cites Welfare and Institutions Code section 10271, which requires annual verification of the parent's or caretaker's physical or mental incapacity when that incapacity is the basis of need for subsidized child care and development services.

How many hours of child care can the CCD 27 support?

The health professional fills in start and end times for each day the parent cannot care for or supervise the children, and the total may not exceed 50 hours in a week. The children's first names and ages are listed in Part I.

Who can sign California's Statement of Parental Incapacity?

A legally qualified health professional treating the parent, such as a physician, psychologist or licensed clinical social worker. They sign Part II and give their license number, the date, and any medical group or organization they are affiliated with.