The Application for Child Specific Respite Services Existing Level 5 Foster Home form fulfills the requirements of DCF 56.14(7)(m) for making a respite request to the DCF Level 5 Exceptions Panel. A Level 5 foster home may only provide respite care to a child who was previously placed in the home, a child specifically identified and approved by the Department on a planned basis, or a child who has needs agreed to by the Department. The form should be submitted to the DCF Level 5 Exceptions Panel when requesting approval from the Department for child specific respite services in an existing Level 5 Foster Home. Personal information you provide may be used for secondary purposes [Privacy Law, s. 15.04(1)(m), Wisconsin Statutes].
DCF-F-5527-E
