Foster Care:  Forms

 

Foster/Treatment Foster and Family-Operated
Group Home Insurance Program
Form Number Title
CFS-2198 Foster Parent Insurance Program Damage Claim Checklist    
(PDF, 29 kb) 
CFS-116 Foster Parent Insurance Program - Claim of Loss or Damage 
(PDF, 9 kb)
DOA 6448 W9 - Taxpayer Identification Number (TIN) Verification   (Exit DHFS; PDF) 
CFS-117 Foster Parent Insurance Program - Verification of Claim (PDF, 8 kb)
Licensing
Form Number Title
CFS-787 Child Foster Care Licensing Checklist  (PDF, 37kb)
DCF-F-CFS0847 Application to DHFS Exceptions Panel for Exception to 
Ch. HFS 56 or Ch. HFS 38  
(PDF, 13 kb)
DCF-F-CFS0847 Application to DHFS Exceptions Panel for Exception to 
Ch. HFS 56 or Ch. HFS 38 
(Word, 68 kb)
DCF-F-CFS2149 Exceptions Panel Second License Application 
(PDF, 41 kb)
DCF-F-CFS2149 Exceptions Panel Second License Application
(Word, 65 kb)
CFS 2187 Foster Care Licensure Notification Form 
(PDF, 24 kb)
CFS-2029 Exceptions Panel Placement of a Non-Treatment Child  (PDF, 47 kb)
CFS-2029 Exceptions Panel Placement of a Non-Treatment Child  (Word, 70 kb)
Placement of Foster Children
Form Number Title
 CFS 872A  Information for Foster Parents Part A (PDF, 100 kb)
 CFS 872B Information for Foster Parents Part B (PDF)
DCF-F-CFS 1590 Voluntary Placement Agreement  (PDF)
DCF-F-CFS-1590 Voluntary Placement Agreement  (Word)
CFS-107 Foster Home Agreement Child Placed in Out-of-Home Care By Agency
 (PDF, 11 kb)
CFS-2189  Out of Home Placement or Recommended Placement Notification  (PDF)
CFS- 997  Medical Services Consent (PDF)
Uniform Foster Care Rate
Form Number Title
DCF-F-CFS-834   Foster Care Uniform Rate Setting Form (PDF)  
DCF-F-CFS-834  Foster Care Uniform Rate Setting Form (Word)  
Other Forms / Information
Form Number Title
CFS-2406 Notice of Client Change of County Residence (PDF)
DCF-F-CFS-2191   Administrative Code HFS 12, Negative Action Notice ( PDF) 
CFS 367  Community Advisory Committee Documentation  (PDF)
 CFS-2186 Foster Parent Notice - Confidentiality of Records  (PDF, 6 kb)
 CFS 383 Group Foster Home Personnel Record Checklist  (PDF, 10 kb) 
CFS 2132  Permanency Plan  (PDF, 230 kb)

Contact Information

Last Revised: November 17, 2009