To apply for a direct incentive grant, an applicant shall submit to the Department an application on the form that the Department requires. The application shall include: The name and address of the child care provider; An itemization of known and estimated costs including a statement from the child care provider as to how the grant funds will be used; The total amount of funds required by the provider to purchase supplies, material, and equipment; The funds available to the applicant to purchase supplies, material, and equipment; The amount of direct incentive grant funds sought from the Department; The number of children that the child care provider serves who receive child care subsidies through the purchase of child care program; and Any other relevant information that the Department requests.