Licensing 622-05-20

Licensing Forms 622-05-20-03

(New 4/26/2017 ML #3503)

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Foster Care for Children licensing form can be found at http://www.nd.gov/eforms. The forms were created to accommodate online and electronic access; each form is fillable and savable. Description of each form and when it should be used is detailed below.

  1. Initial Licensing
    1. SFN 893 “Initial Application To Provide Family Foster Care For Children”
      1. Initial application form is completed by prospective foster parent/s. The initial application must be received by the authorized licensing agent in order for the licensing process to begin.
      2. The Department of Human Services has sixty days from the date of completion of all steps noted on this form, to make a decision on the application. Upon notice to the prospective foster family, the Department may take an additional forty-five days in which to make its decision. Due to the time limits, prospective families may be contacted regarding interviews and home visits before all the steps of the application have been completed.
    2. SFN 889 “Initial Home Study Foster Care For Children”
      1. Initial home study form is completed by the authorized licensing agent worker thoroughly detailing all information with applicants. This form must be submitted to the Department in conjunction with all required licensing paperwork.

  2. Annual Licensing
    1. SFN 400 “Annual Application To Provide Family Foster Care”
      1. Annual licensing form is completed by the foster parent/s every twelve months. ND foster care licensed or approved (Tribal Affidavit) providers must be re-evaluated. This information is used to update the payment system, gain a better understanding of the family composition and assist the licensing authorized agent with the annual renewal process.
    1. SFN 1941 “Annual Licensing Report-Foster Care For Children”
      1. Annual licensing report/study of the home is completed by the licensing worker. The form will detail relevant information since the date of the last licensure study.

  3. Tribal Affidavit Forms
    1. SFN 400 “Annual Application To Provide Family Foster Care”
      1. i. No initial application required. Approved (Tribal Affidavit) foster parent/s must complete this form in an effort to provide initial and updated information for the ND payment system.
    1. SFN 890 “Affidavit of Compliance in lieu of License for Foster Care For Children”
      1. An affidavit must be signed each year. This is a statement in writing by a representative of a recognized Indian Tribe or an Indian agency stating that a specific home on an Indian reservation meets federal and state requirements to provide foster care in their home. The statement must be subscribed and sworn to before the superintendent of a Tribal agency, the Tribal chairperson, or other authorized person from the Tribe.