STATE OF WISCONSIN
Department of Health and Family Services
Division of Children and Family Services
DCFS Memo Series 2000-08/ACTION
May 25, 2000
Re: KINSHIP CARE DATA FORMS

 

To: Area Administrators/Assistant Area Administrators
Bureau Directors
County Departments of Community Programs Directors
County Departments of Developmental Disabilities
      Services Directors
County Departments of Human Services Directors
County Departments of Social Services Directors
Direct Services Supervisors
Kinship Care Contact Persons
Licensing Chiefs/Section Chiefs
Tribal Chairpersons/Human Services Facilitators
From: Susan N. Dreyfus
Administrator

Document Summary

This memo reissues the revised data care collection forms counties and tribes submit to the Department for the Kinship Care Program.

 Effective October 1, 1999, counties and tribes administering the Kinship Care Program were required to collect additional data elements to meet the federal TANF reporting requirements. The Department advised counties and tribes of the additional data elements in Numbered Memo DCFS 99-13. The current data collection forms (CFS-2100 and CFS-2100A) have been revised to incorporate the additional elements (See Attachments A and B). Counties and tribes administering the Kinship Care Program are also required to report data regarding applicants who are denied Kinship Care benefits. Use the CFS-2147 form (Attachment C) to report this denial information.

The revised CFS-2100 and CFS-2100A forms, as well as the new CFS-2147 form, were published in December of 1999, but apparently were not fully distributed. Those counties that did receive the revised forms may notice that several technical corrections have been made for this re-issuance of the forms. Please begin using the revised CFS-2100 and CFS-2100A forms (dated 4/2000), as well as the new CFS-2147 form (dated 12/99), immediately. Please destroy all other versions of these forms.

Collecting Information Back to October 1, 1999

  1. Counties and tribes must complete a CFS-2147 on all applicants who were denied Kinship Care on or after October 1, 1999. Please complete and submit the CFS-2147 forms by Friday, July 14, 2000.

  2. Counties and tribes have two options for reporting the additional data on approved cases for which the county or tribe has paid kinship benefits anytime since October 1, 1999. Please report the additional data, using either alternative, by Friday, July 14, 2000:
  1. Counties and tribes may complete and submit revised CFS-2100 and CFS-2100A forms for each case. You need only complete the fields necessary to identify the case and provide information on the new data elements.

  2. Alternatively, counties and tribes may submit a report that includes the necessary identifying information and the new data fields for all cases for which payment was made since October 1, 1999.

A.  CFS-2100A.  CFS-2100:

Please include the following identifying information, listed by CFS-2100 item number, when reporting back data:

#1.  Kinship Care Case Number (this may be obtained from the reports the Division
        sent to counties under the April 21, 2000 memo from Robin Ryan)

#2.  CARES Case Number

#3.  County or Tribe Name

#5.  Caregiver Full Name

#6.  Caregiver Birthdate

Please provide information on the following new data elements, listed by CFS-2100 item number, when reporting back data:

#9.  Applicant’s Ethnicity: the question as to whether the applicant is Hispanic or not
        is new; also the ability to check more than one race indicator is new.

#11. Caregiver’s Social Security Number

#12. Relative Household Type: several options have been added.

#13. Caregiver Marital Status

#14. Caregiver Education Level

#15. Caregiver Employment Status

B.  CFS-2100A

Please include the following identifying information, listed by item CFS-2100A item number, when reporting back data:

#16. Kinship Child Sequence (this may be obtained from the reports the Division
         sent to counties under the April 21, 2000 memo from Robin Ryan)

#17. CARES Child Pin

#18. Child’s Social Security Number

#19. Child Birthdate

Please provide information on the following new data elements, listed by CFS-2100A item number on the form, when reporting back data:

#22. Child Ethnicity: the question as to whether the applicant is Hispanic or not is
         new

#23. Child Race: the ability to check more than one race indicator is new

#39. Primary reason child no longer receives Kinship Care: four options have been
        added:

(1. Caregiver failed criminal background check; 2. Other household member failed criminal background check; 3. Caregiver relative voluntarily closed case; and 4. Child’s parent(s) living with child)

Instructions for completing the forms:

Please refer to Numbered Memo DCFS 99-07 for instructions on completing the CFS-2100 and CFS-2100A forms. Agencies administering Kinship Care will submit CFS-2147 reports with the same frequency as the CFS-2100 and CFS-2100A, by the 20th of the month following the month in which the form was completed.

Agencies should report on applicants who have been placed on a waitlist only when a final determination is made on their application. The agency will complete the CFS-2100 and CFS-2100A when and if the agency begins making Kinship benefit payments. The agency will complete the CFS-2147 if the applicant is removed from the waiting list because the agency makes a determination that the applicant is ineligible for Kinship Care benefits.

Please continue reporting waiting list status with your monthly kinship care data reports. Please state whether your agency had a waiting list in the previous month and, if so, how many children were on the waiting list.

In cases of multiple caregiver households, the agency must identify a primary caretaker in order to complete information about applicant ethnicity, applicant race, caretaker marital status, caretaker education level, and caretaker employment status.

Availability of Forms

The forms in Attachments A, B and C are available from the Division forms unit and can be ordered in the same manner as any other Division form.

REGIONAL OFFICE CONTACT: Area Administrator
CENTRAL OFFICE CONTACT: Robin Ryan
Kinship Care Program Manager
DCFS/BPP
P. O. Box 8916
Madison, WI 53708-8919
(608) 261-8316

Attachments:  
Kingship Care:  Case Data Collection Form, Part A  (PDF) (17KB)    (Word)
Kinship Care:  Case Data Collection Form Part B  (PDF) (15KB)    (Word)
Kinship Care Application Denial Report  (PDF)  (11KB)    (Word)

cc Linda Kammerude, BIS
Nancie Young, OSF/TAU

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