Department of Health and Family Services
Division of Children and Family Services

               DCFS Memo Series 2002-17
                     December 23, 2002

               Re: REVISED CHILD ABUSE AND
                     NEGLECT INVESTIGATION
                     REPORT (FORM CFS-40)

                    Replaces DCS 96-05, 
                    DCFS 2000-1and DCFS 2002-03



Area Administrators/Assistant Area Administrators
County Departments of Human Services Directors
County Departments of Social Services Directors


Susan N. Dreyfus

Document Summary

This memo distributes a revised CFS-40 from and instruction booklet. The new form must be used for all cases beginning January 1, 2003.

On March 1, 2002, new forms and instructions for data collection through the CFS-40 became effective. Numbered Memo DCFS 2002-03 was issued explaining the changes and each agency was provided a copy of the new CFS-40 report form and accompanying instructions along with directions for ordering additional copies. Due to errors in printing, we have revised both the CFS-40 report form and accompanying instructions to reflect the needed changes.

The errors contained on both the form and instruction booklet relate to race and ethnicity codes, as well as the sequencing of field numbers. The back of the CFS-40 report form outlines the fields contained on the front of the form along with the coding options. The field titled "Ethnicity" has been revised to "Race." In 1997, the federal government made changes in how it captures information concerning a person's race and ethnicity, distinguishing the two as separate categories. On the CFS-40 form, in the field titled "Ethnicity" (now revised to Race) the code choice of "W= white" was inadvertently omitted. This is a code option and should be utilized as appropriate. Page 16 of the instruction booklet reflects the correct code choices. Also on the form under the Ethnicity field, the fields are incorrectly identified as Field 16 and Field 20. The correct field identifications are Field 15 and Field 19. Omitted on the front of the form was a field to capture information on the ethnicity of the maltreater. This has been added to the revised CFS-40 report form and is now captured under Field 16.

The instruction booklet contains errors in the sequencing of field numbers for Age, Sex (page 15) and Ethnicity (now revised to Race - page 16). The correct field numbers are as follows:

AGE (Field 13, Field 17)
SEX (Field 14, Field 18)
Race (Field 15, Field 19)

Revised on both the CFS-40 report form and the instruction booklet is the direction that county agencies are to submit the white copy of the CFS-40 form to the Department within 10 working days of completion of the investigation assessment.

Enclosed is a small supply of new CFS-40 report forms and instruction booklets for your agency. For all reports received by your agency on or after January 1, 2003, please use the new, enclosed forms, and discard all previous report forms and instructions.  If the supply provided is not adequate to meet the needs of your agency, please order additional forms and instruction booklets. Directions for ordering the form and booklet can be found on the first page of the instruction booklet.

 We apologize for the confusion and inconvenience this may have caused you and your staff. If you have any questions with regard to the changes, please contact Amy Smith, Child Protective Services Specialist, at (608) 267-7732 or by e-mail at .


Area Administrator


Amy Smith
Child Protective Services Specialist
P.O. Box 8916
Madison, WI 53708-8916
Phone: (608) 267-7732

Sample of CFS-40 form (pdf- 35 kb)


Bureau Directors/ Licensing Chiefs/Section Chiefs
County Departments of Community Programs
County Departments of Developmental Disabilities Services Directors
CPS Supervisors
Tribal Chairpersons/Human Services Facilitators

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