Although states must certify that they have requirements to protect the health and safety of children in child care in order to receive Child Care and Development Block Grant funds, neither the scope nor stringency of these requirements has been stipulated. At the request of Congressional members, this report identifies the most critical licensing/enforcement activities that help states ensure child safety and health in child care, describes the extent to which states conduct these activities for regulated providers, and explains how states ensure that nonregulated providers receiving block grant funds meet the law's safety and health requirements. Information sources included a literature search, interviews with child care licensing experts and state/federal officials, and a national survey of state licensing directors. Among the licensing/enforcement activities recommended in the findings are criminal background checks and child abuse registry checks on prospective providers, and frequent, unannounced monitoring visits. Most states' policies for background checks and monitoring visits were consistent with recommendations. Success in following recommended practices was related to increases in staff and budgets for licensing offices. Most states reported having an array of sanctions to bring providers into compliance. The states' enforcement activities also satisfy the safety and health requirements of the block grant. For providers that states choose not to regulate, some states nevertheless conduct activities usually reserved for regulated providers; many states inform nonregulated providers of the safety and health requirements and ask them to certify that they will comply with requirements. Appendices provide tables on frequency of state licensure and monitoring visits, state child care licensing budget and full-time-equivalent staffing levels, and state caseloads. (KB)