{"text_format":"1","workbook":"xlsx","n_sheets":6,"sheets":["使い方・注意事項","入力用リスト","【印刷用】提供証明書・領収証兼請求書（認可外保育等）","【白紙】提供証明書・領収証兼請求書（認可外保育等）","【記載例】提供証明書・領収証兼請求書（認可外保育等）","編集不可"],"not_rendered":{"charts":0,"images":8,"macros":1,"external_links":0,"defined_names":5,"comments":1,"pivot_tables":0},"unopened":[],"bounds":{"document_bytes":16777216,"sheet_cells":100000,"rows_first":2000,"rows_last":500,"rows_between":2000,"halvings":0,"cell_chars":16384,"cell_head_chars":4096},"cells_cut":0,"cells_raw":0,"read":"whole","date_system":"1900"}

{"sheet":"使い方・注意事項","index":0,"n_rows":0,"n_cols":0,"rows_kept":0,"cut":false,"hidden":false,"merged":[]}

{"sheet":"入力用リスト","index":1,"n_rows":304,"n_cols":18,"rows_kept":304,"cut":false,"hidden":false,"merged":[[1,0,2,0],[1,1,1,4],[1,5,1,8],[1,9,1,16]]}
[1,2,3,4,5,6,7,8,10,11,12,13,14,15,16,17,18]
["No.","認定子ども　　※全項目の入力が必要です。",null,null,null,"認定保護者　　※全項目の入力が必要です。",null,null,null,"各事業（サービス）の提供状況　　※全項目の入力が必要です。（「自由記載欄(任意)」を除く）",null,null,null,null,null,null,null,"幼稚園との併用"]
[null,"氏名","氏名フリガナ","生年月日","認定番号(新2号、新3号)","氏名","氏名フリガナ","生年月日","現住所","対象事業","対象年","対象月","提供期間（開始日）","提供期間（終了日）","利用料（無償化対象）","特定費用（無償化対象外）","自由記載欄（任意）","（上限額11,300／16,300円）"]
[0,"札幌　花","サッポロ　ハナ","2014-01-12",1234567899,"札幌　一郎","サッポロ　イチロウ","1984-05-06","札幌市中央区南1条東1丁目3-122","1　認可外保育施設",1,10,1,31,12000,1500,"記載例のため編集不可（印刷はされません）","併用ではない"]
[1,"札幌　花","サッポロ　ハナ","2017-03-31",1234567899,"札幌　一郎","サッポロ　イチロウ","1984-05-06","札幌市中央区南1条東1丁目3-122","1　認可外保育施設",2,4,1,30,50000,1500]
[2,"札幌　海","サッポロ　ウミ","2017-04-01",1234567889,"札幌　一郎","サッポロ　イチロウ","1984-05-06","札幌市中央区南1条東1丁目3-122","2　一時預かり事業",2,4,1,30,50000,1500,null,"併用"]
[3,"石狩　五郎","イシカリ　ゴロウ","2017-04-02",55555,"石狩　太朗","イシカリ　タロウ","1983-08-08","札幌市西区中町10条10丁目1-11","3　病児・病後児保育事業",2,4,1,30,50000,1200,null,"併用"]
[4,"非常に長い苗字と　非常に長い名前を持つ","ヒジョウニナガイミョウジトヒジョウニナガイナマエヲモツ","2021-02-02",12334,"非常に長い苗字と　非常に長い名前を持つ","ヒジョウニナガイミョウジトヒジョウニナガイナマエヲモツ","1983-08-08","非常に長い住所非常に長い住所非常に長い住所","2　一時預かり事業",3,2,1,28,42000,0]
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[]
[null,null,"提供証明書兼領収証（一時預かり・認可外保育施設等）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"☆"]
[null,null,"保護者\n\n(認定保護者)",null,null,null,"フリガナ",null,null,{"$f":"VLOOKUP($AX$3,入力用リスト!$A$4:$Q$304,7,FALSE)&\"\"","v":"サッポロ　イチロウ"},null,null,null,null,null,null,null,null,null,null,null,null,"利用した\n児童\n(認定子ども)",null,null,null,"フリガナ",null,null,null,{"$f":"VLOOKUP($AX$3,入力用リスト!$A$4:$Q$304,3,FALSE)&\"\"","v":"サッポロ　ハナ"},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"表示・印刷したい番号",1]
[null,null,null,null,null,null,"氏　名",null,null,{"$f":"VLOOKUP($AX$3,入力用リスト!$A$4:$Q$304,6,FALSE)&\"\"","v":"札幌　一郎"},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"氏　名",null,null,null,{"$f":"VLOOKUP($AX$3,入力用リスト!$A$4:$Q$304,2,FALSE)&\"\"","v":"札幌　花"}]
[]
[null,null,null,null,null,"提供内容並びに領収額及びその費用の内訳"]
[null,null,"特定子ども・子育て支援の内容\n注）□にレを記入",null,null,null,null,null,null,null,null,null,null,null,"提供年月",null,null,null,null,"提供期間",null,null,null,null,null,null,"利用料\n無償化対象※1",null,null,null,null,null,null,"特定費用\n無償化対象外※2",null,null,null,null,null,"施設自由\n記載欄"]
[]
[null,null,{"$f":"IF(VLOOKUP($AX$3,入力用リスト!$A$4:$Q$304,10,FALSE)=\"1　認可外保育施設\",\"☑\",\"□\")","v":"☑"},"認可外保育施設",null,null,null,null,null,null,null,null,null,null,{"$f":"VLOOKUP($AX$3,入力用リスト!$A$4:$R$304,11,FALSE)&\"\"","v":"2"},null,"年",{"$f":"VLOOKUP($AX$3,入力用リスト!$A$4:$R$304,12,FALSE)&\"\"","v":"4"},"月",{"$f":"VLOOKUP($AX$3,入力用リスト!$A$4:$R$304,13,FALSE)&\"\"","v":"1"},null,"日","～",{"$f":"VLOOKUP($AX$3,入力用リスト!$A$4:$R$304,14,FALSE)&\"\"","v":"30"},null,"日",{"$f":"IF(VLOOKUP($AX$3,入力用リスト!$A$4:$R$304,15,FALSE)=0,\"\",VLOOKUP($AX$3,入力用リスト!$A$4:$R$304,15,FALSE))","v":50000},null,null,null,null,null,"円",{"$f":"IF(VLOOKUP($AX$3,入力用リスト!$A$4:$R$304,16,FALSE)=0,\"\",VLOOKUP($AX$3,入力用リスト!$A$4:$R$304,16,FALSE))","v":1500},null,null,null,null,"円",{"$f":"IF(VLOOKUP($AX$3,入力用リスト!$A$4:$R$304,17,FALSE)=0,\"\",VLOOKUP($AX$3,入力用リスト!$A$4:$R$304,17,FALSE))","v":""}]
[null,null,{"$f":"IF(VLOOKUP($AX$3,入力用リスト!$A$4:$Q$304,10,FALSE)=\"2　一時預かり事業\",\"☑\",\"□\")","v":"□"},"一時預かり事業"]
[null,null,{"$f":"IF(VLOOKUP($AX$3,入力用リスト!$A$4:$Q$304,10,FALSE)=\"3　病児・病後児保育事業\",\"☑\",\"□\")","v":"□"},"病児・病後児保育事業"]
[null,null,"○標準的な利用時間（提供時間帯）は、札幌市に届出た確認申請書のとおり。（異なる場合は施設自由記載欄に記入）"]
[null,null,"※1　利用料は無償化の対象となる利用料（特定子ども・子育て支援利用料）の額。利用料の設定が月単位を超える（四半期等）場合"]
[null,null," 　　当該利用料を当該期間の月数で除して、利用料の月額相当分を算定して下さい。（10円未満の端数がある場合は切り捨て）　　"]
[null,null,"※2　日用品、文房具、行事参加費、食材料費、通園送迎費等、無償化の対象とならない費用の額"]
[]
[null,null,"上記のとおり、認定子どもに対し特定子ども・子育て支援を提供したこと、及び認定保護者から特定子ども・子育て支援利用料等として上記の金額を受領したことを証明します。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"年",null,null,"月",null,null,"日"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"施設・事業所名称"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"施設・事業所所在地"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"施設・事業所の\n代表者職氏名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"印"]
[]
[null,null,"※以下、請求者（認定保護者）記入欄\n",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"※本書類は返却いたしません。切り取らず、そのままご記入ください。\n"]
[null,null,"（宛先）札幌市長",null,null,null,null,null,"施設等利用費請求書（一時預かり・認可外保育施設等）"]
[null,null,"私は、子ども・子育て支援法第30条の11第１項の規定に基づき、施設等利用費の給付について、下記の通り請求しますので、"]
[null,null,"別途申し出る償還払いの振込先口座に振り込んでください。なお、施設等利用費の審査にあたり、次の事項に同意します。"]
[null,null,"１．申請者と認定子どもが、札幌市内に居住していることを札幌市が住民基本台帳で確認すること。"]
[null,null,"２．実際に利用していることや、利用料の支払い状況を札幌市が対象施設や保護者に確認すること。"]
[null,null,"３．課税状況を札幌市が確認すること。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"請求日",null,null,"令和",null,null,"年",null,null,"月",null,null,"日"]
[null,null,"1. 請求する保護者（認定保護者）"]
[null,null,"フリガナ",null,null,null,{"$f":"VLOOKUP($AX$3,入力用リスト!$A$4:$Q$304,7,FALSE)&\"\"","v":"サッポロ　イチロウ"},null,null,null,null,null,null,null,null,null,null,null,"生年月日　",null,null,null,null,null,null,null,{"$f":"IF(VLOOKUP($AX$3,入力用リスト!$A$4:$R$304,8,FALSE)=0,\"\",TEXT(VLOOKUP($AX$3,入力用リスト!$A$4:$R$304,8,FALSE),\"ggge\")&\"(\"&YEAR(VLOOKUP($AX$3,入力用リスト!$A$4:$R$304,8,FALSE))&\")\")","v":"昭和59(1984)"},null,null,null,null,null,null,null,null,null,"年",{"$f":"IF(VLOOKUP($AX$3,入力用リスト!$A$4:$R$304,8,FALSE)=0,\"\",MONTH(VLOOKUP($AX$3,入力用リスト!$A$4:$R$304,8,FALSE)))","v":5},null,"月",{"$f":"IF(VLOOKUP($AX$3,入力用リスト!$A$4:$R$304,8,FALSE)=0,\"\",DAY(VLOOKUP($AX$3,入力用リスト!$A$4:$R$304,8,FALSE)))","v":6},null,"日"]
[null,null,"氏　　名",null,null,null,{"$f":"VLOOKUP($AX$3,入力用リスト!$A$4:$Q$304,6,FALSE)&\"\"","v":"札幌　一郎"},null,null,null,null,null,null,null,null,null,"印",null,"現住所",null,null,null,null,null,null,null,{"$f":"VLOOKUP($AX$3,入力用リスト!$A$4:$R$304,9,FALSE)&\"\"","v":"札幌市中央区南1条東1丁目3-122"}]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"日中連絡のつきやすい電話番号"]
[]
[null,null,"2. 利用した児童（認定子ども）"]
[null,null,"フリガナ",null,null,null,{"$f":"VLOOKUP($AX$3,入力用リスト!$A$4:$Q$304,3,FALSE)&\"\"","v":"サッポロ　ハナ"},null,null,null,null,null,null,null,null,null,null,null,"認定番号(新2号、新3号)",null,null,null,null,null,null,null,{"$f":"IF(VLOOKUP($AX$3,入力用リスト!$A$4:$R$304,5,FALSE)=0,\"\",TEXT(VLOOKUP($AX$3,入力用リスト!$A$4:$R$304,5,FALSE),\"0000000000\"))","v":"1234567899"}]
[null,null,"氏　　名",null,null,null,{"$f":"VLOOKUP($AX$3,入力用リスト!$A$4:$Q$304,2,FALSE)&\"\"","v":"札幌　花"},null,null,null,null,null,null,null,null,null,null,null,"生　年　月　日",null,null,null,null,null,null,null,{"$f":"IF(VLOOKUP($AX$3,入力用リスト!$A$4:$R$304,4,FALSE)=0,\"\",TEXT(VLOOKUP($AX$3,入力用リスト!$A$4:$R$304,4,FALSE),\"ggge\")&\"(\"&YEAR(VLOOKUP($AX$3,入力用リスト!$A$4:$R$304,4,FALSE))&\")\")","v":"平成29(2017)"},null,null,null,null,null,null,null,null,null,"年",{"$f":"IF(VLOOKUP($AX$3,入力用リスト!$A$4:$R$304,4,FALSE)=0,\"\",MONTH(VLOOKUP($AX$3,入力用リスト!$A$4:$R$304,4,FALSE)))","v":3},null,"月",{"$f":"IF(VLOOKUP($AX$3,入力用リスト!$A$4:$R$304,4,FALSE)=0,\"\",DAY(VLOOKUP($AX$3,入力用リスト!$A$4:$R$304,4,FALSE)))","v":31},null,"日"]
[]
[]
[]
[null,null,"3. 認可外保育施設等の利用における施設等利用費の償還払い請求額"]
[null,null,"請求対象\n年月",null,null,null,{"$f":"VLOOKUP($AX$3,入力用リスト!$A$4:$R$304,11,FALSE)&\"\"","v":"2"},null,"年",null,{"$f":"VLOOKUP($AX$3,入力用リスト!$A$4:$R$304,12,FALSE)&\"\"","v":"4"},null,"月",null,"利用月分",null,null,null,"請求額※",null,null,null,null,null,null,null,{"$f":"IF(VLOOKUP($AX$3,入力用リスト!$A$4:$R$304,18,FALSE)=\"併用\",IF(AA9=\"\",\"\",IFERROR(IF(MIN(AA9,AA9,IF(IFERROR(DATEDIF(VLOOKUP($AX$3,入力用リスト!$A$4:$S$304,4,FALSE),DATE(YEAR(EDATE(DATE(O9+2018,R9,1),-3)),4,1),\"Y\"),0)>2,11300,16300))=0,\"\",MIN(AA9,AA9,IF(IFERROR(DATEDIF(VLOOKUP($AX$3,入力用リスト!$A$4:$S$304,4,FALSE),DATE(YEAR(EDATE(DATE(O9+2018,R9,1),-3)),4,1),\"Y\"),0)>2,11300,16300))),\"\")),IF(AA9=\"\",\"\",IFERROR(IF(MIN(AA9,AA9,IF(IFERROR(DATEDIF(VLOOKUP($AX$3,入力用リスト!$A$4:$S$304,4,FALSE),DATE(YEAR(EDATE(DATE(O9+2018,R9,1),-3)),4,1),\"Y\"),0)>2,37000,42000))=0,\"\",MIN(AA9,AA9,IF(IFERROR(DATEDIF(VLOOKUP($AX$3,入力用リスト!$A$4:$S$304,4,FALSE),DATE(YEAR(EDATE(DATE(O9+2018,R9,1),-3)),4,1),\"Y\"),0)>2,37000,42000))),\"\")))","v":37000},null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円"]
[null,null,"※月額上限額は、施設等利用給付第2号認定の場合は月額37,000円、第3号認定の場合は42,000円です。\nただし、幼稚園・認定こども園に通われている方は、第2号認定の場合は月額11,300円、第3号認定の場合は16,300円です。\n月途中で認定期間が終了、又は開始される場合、月額限度額は次の通りとなります。\n・月途中で認定期間が終了する場合：37,000(42,000)円× 終了日までの日数÷その月の日数\n・月途中で認定期間が開始する場合：37,000(42,000)円× 認定日からの日数÷その月の日数\n"]
[]
[]
[]
[null,null,"4．（複数施設の利用分をまとめて請求する場合のみ）添付する提供証明書・領収証の枚数　（本紙は含みません）"]
[null,null,"添付枚数",null,null,null,null,null,null,null,null,null,null,null,null,null,"枚"]
[null,null,"※月に複数施設を利用した場合、請求書部分を都度記載する手間を省略するため、同月の他の「特定子ども・子育て支援提供証明書兼領収書」をまとめて左上でホチキス留めし、上記の請求金額欄に合算してください。なお、さっぽろ子育てサポートセンターを利用した場合は「援助活動報告書」、札幌市こども緊急サポートネットワークを利用した場合は「援助活動の報告」又は「病児保育の報告書」を添付してください。"]
[]
[null,"「初めて請求・振込口座を変更」する方は別紙「振込口座申出書」もご提出ください。"]

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[]
[null,null,"提供証明書兼領収証（一時預かり・認可外保育施設等）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"☆"]
[null,null,"保護者\n\n(認定保護者)",null,null,null,"フリガナ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"利用した\n児童\n(認定子ども)",null,null,null,"フリガナ"]
[null,null,null,null,null,null,"氏　名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"氏　名"]
[]
[null,null,null,null,null,"提供内容並びに領収額及びその費用の内訳"]
[null,null,"特定子ども・子育て支援の内容\n注）□にレを記入",null,null,null,null,null,null,null,null,null,null,null,"提供年月",null,null,null,null,"提供期間",null,null,null,null,null,null,"利用料\n無償化対象※1",null,null,null,null,null,null,"特定費用\n無償化対象外※2",null,null,null,null,null,"施設自由\n記載欄"]
[]
[null,null,"□","認可外保育施設",null,null,null,null,null,null,null,null,null,null,null,null,"年",null,"月",null,null,"日","～",null,null,"日",null,null,null,null,null,null,"円",null,null,null,null,null,"円"]
[null,null,"□","一時預かり事業"]
[null,null,"□","病児・病後児保育事業"]
[null,null,"○標準的な利用時間（提供時間帯）は、札幌市に届出た確認申請書のとおり。（異なる場合は施設自由記載欄に記入）"]
[null,null,"※1　利用料は無償化の対象となる利用料（特定子ども・子育て支援利用料）の額。利用料の設定が月単位を超える（四半期等）場合"]
[null,null," 　　当該利用料を当該期間の月数で除して、利用料の月額相当分を算定して下さい。（10円未満の端数がある場合は切り捨て）　　"]
[null,null,"※2　日用品、文房具、行事参加費、食材料費、通園送迎費等、無償化の対象とならない費用の額"]
[]
[null,null,"上記のとおり、認定子どもに対し特定子ども・子育て支援を提供したこと、及び認定保護者から特定子ども・子育て支援利用料等として上記の金額を受領したことを証明します。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"年",null,null,"月",null,null,"日"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"施設・事業所名称"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"施設・事業所所在地"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"施設・事業所の\n代表者職氏名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"印"]
[]
[null,null,"※以下、請求者（認定保護者）記入欄\n",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"※本書類は返却いたしません。切り取らず、そのままご記入ください。\n"]
[null,null,"（宛先）札幌市長",null,null,null,null,null,"施設等利用費請求書（一時預かり・認可外保育施設等）"]
[null,null,"私は、子ども・子育て支援法第30条の11第１項の規定に基づき、施設等利用費の給付について、下記の通り請求しますので、"]
[null,null,"別途申し出る償還払いの振込先口座に振り込んでください。なお、施設等利用費の審査にあたり、次の事項に同意します。"]
[null,null,"１．申請者と認定子どもが、札幌市内に居住していることを札幌市が住民基本台帳で確認すること。"]
[null,null,"２．実際に利用していることや、利用料の支払い状況を札幌市が対象施設や保護者に確認すること。"]
[null,null,"３．課税状況を札幌市が確認すること。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"請求日",null,null,"令和",null,null,"年",null,null,"月",null,null,"日"]
[null,null,"1. 請求する保護者（認定保護者）"]
[null,null,"フリガナ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"生年月日　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"年",null,null,"月",null,null,"日"]
[null,null,"氏　　名",null,null,null,null,null,null,null,null,null,null,null,null,null,"印",null,"現住所"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"日中連絡のつきやすい電話番号"]
[]
[null,null,"2. 利用した児童（認定子ども）"]
[null,null,"フリガナ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"認定番号(新2号、新3号)"]
[null,null,"氏　　名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"生　年　月　日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"年",null,null,"月",null,null,"日"]
[]
[]
[]
[null,null,"3. 認可外保育施設等の利用における施設等利用費の償還払い請求額"]
[null,null,"請求対象\n年月",null,null,null,null,null,"年",null,null,null,"月",null,"利用月分",null,null,null,"請求額※",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円"]
[null,null,"※月額上限額は、施設等利用給付第2号認定の場合は月額37,000円、第3号認定の場合は42,000円です。\nただし、幼稚園・認定こども園に通われている方は、第2号認定の場合は月額11,300円、第3号認定の場合は16,300円です。\n月途中で認定期間が終了、又は開始される場合、月額限度額は次の通りとなります。\n・月途中で認定期間が終了する場合：37,000(42,000)円× 終了日までの日数÷その月の日数\n・月途中で認定期間が開始する場合：37,000(42,000)円× 認定日からの日数÷その月の日数\n"]
[]
[]
[]
[null,null,"4．（複数施設の利用分をまとめて請求する場合のみ）添付する提供証明書・領収証の枚数　（本紙は含みません）"]
[null,null,"添付枚数",null,null,null,null,null,null,null,null,null,null,null,null,null,"枚"]
[null,null,"※月に複数施設を利用した場合、請求書部分を都度記載する手間を省略するため、同月の他の「特定子ども・子育て支援提供証明書兼領収書」をまとめて左上でホチキス止めし、上記の請求金額欄に合算してください。なお、さっぽろ子育てサポートセンターを利用した場合は「援助活動報告書」、札幌市こども緊急サポートネットワークを利用した場合は「援助活動の報告」又は「病児保育の報告書」を添付してください。"]
[]
[null,"「初めて請求・振込口座を変更」する方は別紙「振込口座申出書」もご提出ください。"]

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[]
[]
[]
[]
[null,null,"提供証明書兼領収証（一時預かり・認可外保育施設等）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"☆"]
[null,null,"保護者\n\n(認定保護者)",null,null,null,"フリガナ",null,null,"サッポロ　イチロウ",null,null,null,null,null,null,null,null,null,null,null,null,"利用した\n児童\n(認定子ども)",null,null,null,"フリガナ",null,null,null,"サッポロ　ハナ"]
[null,null,null,null,null,null,"氏　名",null,null,"札幌　一郎",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"氏　名",null,null,null,"札幌　花"]
[]
[null,null,null,null,null,"提供内容並びに領収額及びその費用の内訳"]
[null,null,"特定子ども・子育て支援の内容\n注）□にレを記入",null,null,null,null,null,null,null,null,null,null,null,"提供年月",null,null,null,null,"提供期間",null,null,null,null,null,null,"利用料\n無償化対象※1",null,null,null,null,null,null,"特定費用\n無償化対象外※2",null,null,null,null,null,"施設自由\n記載欄"]
[]
[null,null,"□","認可外保育施設",null,null,null,null,null,null,null,null,null,null,1,null,"年",10,"月",1,null,"日","～",31,null,"日",42000,null,null,null,null,null,"円",null,null,null,null,null,"円"]
[null,null,"☑","一時預かり事業"]
[null,null,"□","病児・病後児保育事業"]
[null,null,"○標準的な利用時間（提供時間帯）は、札幌市に届出た確認申請書のとおり。（異なる場合は施設自由記載欄に記入）"]
[null,null,"※1　利用料は無償化の対象となる利用料（特定子ども・子育て支援利用料）の額。利用料の設定が月単位を超える（四半期等）場合"]
[null,null," 　　当該利用料を当該期間の月数で除して、利用料の月額相当分を算定して下さい。（10円未満の端数がある場合は切り捨て）　　"]
[null,null,"※2　日用品、文房具、行事参加費、食材料費、通園送迎費等、無償化の対象とならない費用の額"]
[]
[null,null,"上記のとおり、認定子どもに対し特定子ども・子育て支援を提供したこと、及び認定保護者から特定子ども・子育て支援利用料等として上記の金額を受領したことを証明します。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1,null,null,"年",11,null,"月",1,null,"日"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"施設・事業所名称",null,null,null,null,null,"■△幼稚園"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"施設・事業所所在地",null,null,null,null,null,"札幌市白石区菊水１条１丁目○番○号"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"施設・事業所の\n代表者職氏名",null,null,null,null,null,"　　　　　給付　太郎",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"印"]
[]
[null,null,"※以下、請求者（認定保護者）記入欄\n",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"※本書類は返却いたしません。切り取らず、そのままご記入ください。\n"]
[null,null,"（宛先）札幌市長",null,null,null,null,null,"施設等利用費請求書（一時預かり・認可外保育施設等）"]
[null,null,"私は、子ども・子育て支援法第30条の11第１項の規定に基づき、施設等利用費の給付について、下記の通り請求しますので、"]
[null,null,"別途申し出る償還払いの振込先口座に振り込んでください。なお、施設等利用費の審査にあたり、次の事項に同意します。"]
[null,null,"１．申請者と認定子どもが、札幌市内に居住していることを札幌市が住民基本台帳で確認すること。"]
[null,null,"２．実際に利用していることや、利用料の支払い状況を札幌市が対象施設や保護者に確認すること。"]
[null,null,"３．課税状況を札幌市が確認すること。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"請求日",null,null,"令和",null,1,"年",11,null,"月",5,null,"日"]
[null,null,"1. 請求する保護者（認定保護者）"]
[null,null,"フリガナ",null,null,null,"サッポロ　イチロウ",null,null,null,null,null,null,null,null,null,null,null,"生年月日　",null,null,null,null,null,null,null,"昭和59",null,null,null,null,null,null,null,null,null,"年",11,null,"月",5,null,"日"]
[null,null,"氏　　名",null,null,null,"札幌　一郎",null,null,null,null,null,null,null,null,null,"印",null,"現住所",null,null,null,null,null,null,null,"札幌市中央区南1条東1丁目3－122"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"日中連絡のつきやすい電話番号",null,null,null,null,null,null,null,null,"090-XXXX-XXXX"]
[]
[null,null,"2. 利用した児童（認定子ども）"]
[null,null,"フリガナ",null,null,null,"サッポロ　ハナ",null,null,null,null,null,null,null,null,null,null,null,"認定番号(新2号、新3号)",null,null,null,null,null,null,null,"0000000000"]
[null,null,"氏　　名",null,null,null,"札幌　花",null,null,null,null,null,null,null,null,null,null,null,"生　年　月　日",null,null,null,null,null,null,null,"平成26",null,null,null,null,null,null,null,null,null,"年",1,null,"月",12,null,"日"]
[]
[]
[]
[null,null,"3. 認可外保育施設等の利用における施設等利用費の償還払い請求額"]
[null,null,"請求対象\n年月",null,null,null,1,null,"年",null,10,null,"月",null,"利用月分",null,null,null,"請求額※",null,null,null,null,null,null,null,42000,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円"]
[null,null,"※月額上限額は、施設等利用給付第2号認定の場合は月額37,000円、第3号認定の場合は42,000円です。\nただし、幼稚園・認定こども園に通われている方は、第2号認定の場合は月額11,300円、第3号認定の場合は16,300円です。\n月途中で認定期間が終了、又は開始される場合、月額限度額は次の通りとなります。\n・月途中で認定期間が終了する場合：37,000(42,000)円× 終了日までの日数÷その月の日数\n・月途中で認定期間が開始する場合：37,000(42,000)円× 認定日からの日数÷その月の日数\n"]
[]
[]
[]
[null,null,"4．（複数施設の利用分をまとめて請求する場合のみ）添付する提供証明書・領収証の枚数　（本紙は含みません）"]
[null,null,"添付枚数",null,null,null,null,null,null,null,null,null,null,null,null,null,"枚"]
[null,null,"※月に複数施設を利用した場合、請求書部分を都度記載する手間を省略するため、同月の他の「特定子ども・子育て支援提供証明書兼領収書」をまとめて左上でホチキス留めし、上記の請求金額欄に合算してください。なお、さっぽろ子育てサポートセンターを利用した場合は「援助活動報告書」、札幌市こども緊急サポートネットワークを利用した場合は「援助活動の報告」又は「病児保育の報告書」を添付してください。"]
[]
[null,"「初めて請求・振込口座を変更」する方は別紙「振込口座申出書」もご提出ください。"]

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[null,"事業種類"]
[null,"1　認可外保育施設"]
[null,"2　一時預かり事業"]
[null,"3　病児・病後児保育事業"]