STATE OF WISCONSIN
Department of Health and Family Services
Division of Children and Family Services

          DCFS Memo Series 2001-09
          June 4, 2001
          Re:  Kinship Care Forms and
                 Reporting Procedures

 

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
Licensing Chiefs/Section Chiefs
Tribal Chairpersons/Human Services Facilitators

From:

Susan N. Dreyfus
Administrator

Document Summary

This memo describes the procedures for submitting Kinship Care monthly reports and also includes revised forms to be used for Kinship Care reporting and other Kinship Care activities.

This memo is to update you on the forms to be used for reporting information regarding the Kinship Care Program and the procedures for reporting that information. It is important that these changes be made immediately to assure that we are able to meet our requirements for reporting to the US Department of Health and Human Services. Please discard any older versions of these forms and begin to use these forms immediately.

In order to accommodate the data processing needs of some counties, the date for reporting monthly information to the Division is now the 24th rather than the 20th of the following month (e.g., reports for October are due to the Division no later than November 24th). This will reduce the amount of time we have to process the information so any reporting which can be done prior to the 24th would be appreciated. If required forms or data reports are submitted after the 24th of the month, we will apply the financial penalties described in Memo Series DCFS 99-07.

Attachment A to this memo, CFS-2023, Kinship Care Payment Application, is a voluntary form that may be used by the Kinship Care agency for the applicant to complete in applying for a Kinship Care benefit. Information is contained on this form that is required to be reported to this Department on other forms. This form is not to be submitted to the Department.

Attachment B to this memo, CFS-2024, Kinship Care Payment Eligibility Determination, is a voluntary form that may be used by the Kinship Care agency for the purpose of determining the eligibility of an applicant for a Kinship Care benefit. While the form is voluntary, the content of the form are those eligibility requirements identified by statute and Department policy. This form is not to be submitted to the Department.

Attachment C to this memo, CFS-2093, Kinship Care Good Cause Notice, is a voluntary form although the content must be shared with an applicant for a Kinship Care benefit. The purpose of this form is to alert the applicant to his or her right to request a good cause exemption for not wishing to provide information for the purpose of determining child support. This form is not to be submitted to the Department.

Attachment D to this memo, CFS-2094, Kinship Care Good Cause Claim for Refusing to Cooperate in Obtaining Child and/or Medical Support, is a voluntary form, but the content must be provided to an applicant if they choose to request a good cause claim exemption. The completed form should be submitted to your child support office if you are in agreement with the request. This form is not to be submitted to the Department.

Attachment E to this memo, CFS-2095, Kinship Care Notice of Assignment, Child Support and Medical Assistance, is a voluntary form, but the content must be collected by the Kinship Care agency and maintained in the applicant's/caregiver's case record. This form is not to be submitted to the Department.

Attachment F to this memo, CFS-2096, Kinship Care Referral for Child Support Services, is a mandatory form that must be used in referring cases to the local child support agency. This form is not to be submitted to the Department.

Attachment G to this memo, CFS-2097, Kinship Care Payment Termination Notice, is a voluntary form. The Kinship Care agency and the local child support agency should mutually determine what information should be transmitted between agencies. This form is not to be submitted to the Department.

Attachment H to this memo, CFS-2100, Kinship Care Case Data Collection-Part A, is a mandatory form that must be used by the Kinship Care agency in reporting data to the Department. Instructions have also been included. Please make sure that you use this version of the form (i.e., revised 12/2000) and discard any previous versions. This form must be submitted to the Department on a monthly basis, if necessary.

Attachment I to this memo, CFS-2100A, Kinship Care Case Data Collection-Part B, is a mandatory form that must be used by the Kinship Care agency in reporting data to the Department. Instructions have also been included. Please make sure that you use this version of the form (i.e., revised 12/2000) and discard any previous versions. This form must be submitted to the Department on a monthly basis, if necessary.

Attachment J to this memo, CFS-2147, Kinship Care Application Denial, is a mandatory form that must be used whenever an application is denied. This form must be submitted to the Department on a monthly basis, if necessary.

Attachment K to this memo, CFS-2167, Kinship Care School Verification, is a voluntary form, although the content must be utilized in determining if a child is in good academic standing in order to continue a Kinship Care benefit after the age of 18. This form should be maintained in the child's case record. This form is not to be submitted to the Department.

Attachment L to this memo, CFS-2182, Kinship Care Monthly Report, is a mandatory form which must be utilized by the Kinship Care agency. Please make sure that you use this version of the form (i.e., revised 3/2001) and discard any previous versions. This form must be submitted to the Department on a monthly basis, whether or not there was any case activity during the month. If you are reporting electronically, the information on this form must be provided with the electronic submission.

Attachment M to this memo, CFS-2190, Kinship Care Long-Term Agreement, is a voluntary form although the content is required in written agreements for long-term Kinship Care providers. This form is not to be submitted to the Department.

We are still occasionally receiving completed forms with no cover letter or indication as to whether the forms constitute a monthly report. It is also clear that some agencies are submitting these forms as they are completed. Please submit forms only once per month and be sure they are submitted with the monthly report cover memo (Attachment L).

All forms and data are to be submitted to Ruth Murphy at the address below.

I appreciate your cooperation and assistance in assuring that our reporting is complete and accurate so that Wisconsin can avoid significant federally-imposed financial sanctions.

All of these forms are available on the Department's web site: http://www.dhfs.state.wi.us

There are a limited number of the Kinship Care forms in the DHFS Forms Center. They can be ordered on the Forms/Publication Requisition (DMT-25) and sent to:

Department of Health and Family Services
Forms Manager
P. O. Box 8916
Madison, WI 53708-8916

 

REGIONAL OFFICE CONTACT:

Area Administrator

CENTRAL OFFICE CONTACT:

Program
Paula Brown
Independent Living and 
       Kinship Coordinator
DHFS/DCFS/BPP
P.O. Box 8916
Madison, WI 53708-8916
Phone: (608) 267-7287
FAX: (608) 264-6750
E-mail: brownp@dhfs.state.wi.us

 

Data
Ruth Murphy
Independent Living and Kinship
     Care Program Specialist
DHFS/DCFS/BPP
P.O. Box 8916
Madison, WI 53708-8916
Phone: (608) 266-5330
FAX: (608) 264-6750
E-mail: murphr@dhfs.state.wi.us

Listing of Kinship Care Program Forms

c:

Kinship Care Contact Persons


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