Permanency Planning Forms 624-05-25

(Revised 710/1/2023 ML #3756)

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The following forms are necessary to carry out the case plan and successfully achieve timely permanency for the child in foster care. These forms are used throughout the life of a foster care case.

 

1. SFN 45, Notice of Change: This form is required and must be completed each time changes occur in the child's case; including placement, foster care status, and parent information. The intent of this form is to quickly update/alert the CFS FCSA Eligibility Unit assigned eligibility worker to make payment adjustments accordingly. Overpayments will occur if the eligibility worker is not notified of a placement/status change.
   
   

2. SFN 60, 18+ Continued Care Agreement: This form is only required if a child is voluntary agreeing to remain in or return to the 18+ Continued Care program.
   
   

3. SFN 327, Foster Family Claim of Property Damage: This form is only required if property damage occurs in the foster home and the foster care providers would like to file a claim. The form is completed by the foster care provider and submitted to CFS by the case manager or authorized licensing agent worker within 90 days of the discovery of the property damage.
   
   

4. SFN 348, Compelling Reasons: This form is required only when a case must document compelling reason(s) to not file a petition to terminate parental rights.
   
   

5. DN 402, Foster Youth Rights: This document is required and must be signed annually and on file for all children in foster care age 14 or older.
   
   

6. SFN 494, Transition Checklist: This document is required for all children in foster care turning age 18. The checklist must be completed no greater than 90 days prior to the child’s 18th birthday, this allows time for documentation and items to be collected and provided to the child upon discharge.
   
   

7. SFN 573, Runaway & Missing Youth Screening: This form is required only when a child in foster care is located after running away or going missing. The screening is used to help identify if a child was a victim of sex trafficking or exploited when not under direct supervision and care of a foster care provider.
   
   

8. SFN 772, Absent Parent - Relative Search: This form is not required but may be used to document relative search options verified by the case manager.
   
   

9. SFN 904, Agreement to Receive Excess Maintenance Payment: This form is required when a foster care provider enters into an agreement with North Dakota Department of Health and Human Services and the foster care custodial agency, to receive excess maintenance payments to meet the child’s placement needs.
   
   

10. SFN 928, Agreement to Furnish Shelter Care: This form is required when a foster care provider enters into an agreement to furnish temporary shelter care for children in or out of public custody, arranged for by a public agency to provide a time-limited safe dwelling under the supervision and care of a licensed foster care provider.
    
    

11. SFN 929, Agreement to Furnish Respite Care: This form is required when a foster care provider or licensed child care provider enters into an agreement to furnish temporary respite care for a child with special medical, emotional or behavioral needs, which requires time-limited supervision and care by a licensed provider.
    
    

12. SFN 1033, Foster Child Travel Authorization: This form is intended to provide permission for a child in foster care to travel in-state or out-of-state with another approved party.

     

13. SFN 1040, Reasonable and Prudent Parenting Consent: This form is intended to provide permission for a child in foster care to participate in various activities and events throughout their placement with a foster care provider.

     

14. SFN 1612, Foster Care Verification: This form can be used for all children in foster care exiting public custody as verification of their time in care. This form is required for all foster children over the age of 14 prior to their discharge from care.
    
    

15. SFN 1613, Chafee Referral - Current Foster Youth: This form is required when a custodial case manager is referring children in foster care to the Chafee Transition Program.
    
    

16. SFN 1614, Chafee Referral - Foster Care Alumni: This form is required when a former child in foster care is seeking access to the Chafee Transition Program.
    
    

17. SFN 1865, Child Needs Assessment: This form is required as a needs assessment when an Excess Maintenance Payment (EMP) is being considered. The form is completed by the case manager.
    
    

18. SFN 1944, Request for use of the Federal Parent Locator Service (FPLS) for Child Welfare Services: This form is required when relative search is engaged. The form is completed by case managers and submitted to the assigned CFS Field Service Specialist to formally request address, employment, and other pertinent information on relative parties from HHS Child Support.
    
    SFN 18119, School District Notification: This is an online electronic notification document required by NDDPI for all school aged children in foster care. Notification is required four different times throughout the life of the case (entry, placement changes, September each year, and closure).

     

19. Safety Framework Practice Model Forms: Described in further detail in manual chapter 607-05, the safety framework requires case managers to utilize these forms and tools:

1. Tool 2.1: Present Danger Assessment Form

2. SFN 455: Present Danger Plan Form

3. Tool 2A: Present Danger Assessment and Planning Guide

4. Tool 3B: Impending Danger Threats & Danger Threshold Guide (Hardcard)

5. Tool 4: Safety Plan Form

6. Tool 5: Protective Capacities Family Assessment (PCFA) Form

7. Tool 5A: Parent/Caregiver Protective Capacities Guide (Hardcard)

8. Tool 6: Case Plan Form

9. Tool 7: Protective Capacities Progress Assessment (PCPA) Form

10. Tool 8: Safe Placement Settings Assessment (SPSA)

Foster Care Eligibility/Reimbursement Forms:

1. SFN 630, Foster Care Placement Notification
2. SFN 641, Title IV-E/Title XIX Application
3. SFN 642, Title IV-E/Title XIX Redetermination
4. SFN 903, Provider Reimbursement Request
5. SFN 920, Foster Care – Child Care Invoice
6. SFN 1042, Irregular Foster Care Payments: This form is only completed when the irregular payment requires special instructions, (ex: max mileage vs gas receipt), payment limitations or the irregular payment category does not require a receipt.
7. Additional required forms can be found in manual chapter 623-05.

 

Guardianship

1. SFN 1833, Application for Subsidized Guardianship
2. Additional required forms can be found in manual chapter 623-10

 

Foster parent licensing

1. Licensing forms can be found in manual chapter 622-05.