Licensing Forms 622-05-03

There are no archives for this section.

 

Definitions 622-05-05

April 1, 2022 - May 31, 2024 - 622-05-05 ML 3803

October 1, 2019 - May 31, 2022 - 622-05-05 ML 3677

April 26, 2017 - September 30, 2019 - 622-05-05 ML 3564

February 15, 2014 - April 25, 2017 - 622-05-05 - ML3503

August 15, 2010 - February 14, 2014 - 622-05-05 - ML3398

 

CFS Licensing Unit 622-05-06

June 1, 2022 - May 31, 2024 - 622-05-06 ML 3803

 

Recruitment and Retention 622-05-07

June 1, 2022 - May 31, 2024 - 622-05-07 ML 3803

 

Application to Provide Family Foster Care 622-05-10-05

June 1, 2024 - September 30, 2024 - 622-05-10-05 ML 3867

April 1, 2022 - May 31, 2024 - 622-05-10-05 ML 3803

October 1, 2019 - May 31, 2022 - 622-05-10-05 ML 3677

August 15, 2010 - September 30, 2019 - 622-05-10-05 ML 3564

 

 

Application Qualifications 622-05-10-10

April 1, 2022 - May 31, 2024 - 622-05-10-10 ML 3803

October 1, 2019 - May 31, 2022 - 622-05-10-10 ML 3677

August 15, 2010 - September 30, 2019 - 622-05-10-10 ML 3564

 

 

Financial Stability 622-05-10-10-02

April 1, 2022 - May 31, 2024 - 622-05-10-10-02 ML 3803

October 1, 2019 - May 31, 2022 - 622-05-10-10-02 ML 3677

 

 

HHS License, Certification, Tribal Affidavit Approval Documentation 622-05-10-10-03

April 1, 2022 - May 31, 2024 - 622-05-10-10-03 ML 3803

October 1, 2019 - May 31, 2022 - 622-05-10-10-03 ML 3677

 

 

Data Management System 622-05-10-10-04

April 1, 2022 - May 31, 2024 - 622-05-10-10-04 ML 3803

October 1, 2019 - May 31, 2022 - 622-05-10-10-04 ML 3677

 

Memorandum of Understanding (MOU) of Correction 622-05-10-10-05

April 1, 2022 - May 31, 2024 - 622-05-10-10-05 ML 3803

October 1, 2019 - May 31, 2022 - 622-05-10-10-05 ML 3677

 

 

HHS Liability Coverage 622-05-10-10-06

April 1, 2024 - May 31, 2024 - 622-05-10-10-06 ML 3803

October 1, 2019 - May 31, 2022 - 622-05-10-10-06 ML 3677

April 26, 2017 - September 30, 2019 - 622-05-10-10-05 ML 3564

February 15, 2017 - April 25, 2017 - 622-05-10-10-05 ML 3503

 

Training Requirements 622-05-15-05

April 1, 2022 - May 31, 2024 - 622-05-15-05 ML 3803

October 1, 2019 - May 31, 2022 - 622-05-15-05 ML 3677

 

Foster Care Provider Medical 622-05-15-10

April 1, 2022 - May 31, 2024 - 622-05-15-10 ML 3803

October 1, 2019 - May 31, 2022 - 622-05-15-10 ML 3677

February 1, 2011 - September 30, 2019 - 622-05-15-10 ML 3564

August 15, 2010 - January 31, 2011 - 622-05-15-10

 

 

Family Evacuation & Disaster Planning 622-05-15-16

April 1, 2024 - May 31, 2024 - 622-05-15-16 ML 3803

October 1, 2019 - May 31, 2022 - 622-05-15-16 ML 3677

February 15, 2014 - September 30, 2019 - 622-05-15-16 ML 3564

 

 

Identified Relative Waivers 622-05-15-17

April 1, 2022 - May 31, 2024 - 622-05-15-17 ML 3803

October 1, 2019 - May 31, 2022 - 622-05-15-17 ML 3677

February 15, 2014 - September 30, 2019 - 622-05-15-17 ML 3564

August 15, 2010 - February 14, 2014 - 622-05-15-17 - ML3398

 

 

Home Study Related to Interstate Compact Cases 622-05-15-20

April 1, 2022 - May 31, 2024 - 622-05-15-20 ML 3803

August 15, 2010 - May 31, 2022 - 622-05-15-20 ML 3677

 

 

Background Check for Adults 622-05-15-25

April 1, 2022 - May 31, 2024 - 622-05-15-25 ML 3803

October 1, 2019 - May 31, 2022 - 622-05-15-25 ML 3677

April 26, 2017 - September 30, 2019 - 622-05-15-25 ML 3564

February 15, 2014 - April 25, 2017 - 622-05-15-25 - ML3503

August 15, 2010 - February 14, 2014 - 622-05-15-25 - ML3398

 

 

Annual Onsite & Renewal Licensing Requirements 622-05-15-30

June 1, 2024 - April 1, 2025 - 622-05-15-30 ML 3904

April 1, 2022 - May 31, 2024 - 622-05-15-30 ML 3803

October 1, 2019 - May 31, 2022 - 622-05-15-30 ML 3677

August 15, 2010 - September 30, 2019 - 622-05-15-30 ML 3564

 

Renewal and Exit Survey 622-05-15-32

June 1, 2022 - May 31, 2024 - 622-05-15-32 ML 3803

 

Conflict of Interest - Licensing Agency Staff 622-05-15-35

April 1, 2022 - May 31, 2024 - 622-05-15-35 ML 3803

October 1, 2019 - May 31, 2022 - 622-05-15-35 ML 3677

August 15, 2010 - September 30, 2019 - 622-05-15-35 ML 3564

 

 

Multiethnic Placement Act/Interethnic Adoption Provision (MEPA-IEP) 622-05-15-45

April 1, 2022 - May 31, 2024 - 622-05-15-45 ML 3803

February 15, 2014 - May 31, 2022 - 622-05-15-45 ML 3677

August 15, 2010 - February 14, 2014 - 622-05-15-45 - ML3398

 

 

Licensing Files 622-05-20-05

April 1, 2022 - May 31, 2024 - 622-05-20-05 ML 3803

August 15, 2010 - May 31, 2022 - 622-05-20-05 ML 3677

 

Family Licensing Changes 622-05-20-10

April 1, 2022 - May 31, 2024 - 622-05-20-10 ML 3803

May 1, 2021 - May 31, 2022 - 622-05-20-10 ML 3677

October 1, 2019 - April 30, 2021 - 622-05-20-10 ML 3615

July 24, 2018 - September 30, 2019 - 622-05-20-10 ML 3564

April 26, 2017 - July 23, 2018 - 622-05-20-10 ML3536

February 15, 2014 - April 25, 2017 - 622-05-20-10 - ML3503

August 15, 2010 - February 14, 2014 - 622-05-20-10 - ML3398

 

Amending a License 622-05-20-11

June 1, 2024 - September 30, 2024 - 622-05-20-11 ML 3867

May 31, 2023 - May 31, 2024 - 622-05-20-11 ML 3803

 

 

Transfer of a License - Physical Location 622-05-20-12

April 1, 2022 - May 31, 2024 - 622-05-20-12 ML 3803

October 1, 2019 - May 31, 2022 - 622-05-20-12 ML 3677

 

 

Family Assessment Process 622-05-20-15

April 1, 2022 - My 31, 2024 - 622-05-20-15 ML 3803

August 15, 2010 - May 31, 2022 - 622-05-20-15 ML 3677

 

 

Recruitment and Retention 622-05-20-20-05

REPEALED August 15, 2010 - May 31, 2022 - 622-05-20-20-05 ML 3677

 

 

Family Interviews 622-05-20-17

April 1, 2022 - May 31, 2024 - 622-05-20-17 ML 3803 (Renumbered)

October 1, 2019 - May 31, 2022 - 622-05-20-20-15 ML 3677

February 15, 2014 - September 30, 2019 - 622-05-20-20-15 ML 3564

August 15, 2010 - February 14, 2014 - 622-05-20-20-15 - ML3398

 

Dual Licensure/Certification - Family & Adult Foster Care 622-05-20-19

April 1, 2022 - May 31, 2024 - 622-05-20-19 (Renamed & Renumbered)

August 15, 2010 - May 31, 2022 - 622-05-20-20-25 ML 3677

 

 

Housing 622-05-25-05

October 1, 2024 - March 31, 2025 - 622-05-25-05 ML 3904

June 1, 2024 - September 30, 2024 - 622-05-25-05 ML 3867

April 1, 2024 - May 31, 2024 - 622-05-25-05 ML 3803

October 1, 2019 - May 31, 2022 - 622-05-25-05 ML 3677

August 15, 2010 - September 30, 2019 - 622-05-25-05 ML 3564

 

General Safety Guidelines 622-05-25-30

April 1, 2022 - May 31, 2024 - 622-05-25-30 ML 3803

October 1, 2019 - May 31, 2022 - 622-05-25-30 ML 3677

July 24, 2018 - September 30, 2019 - 622-05-25-30 ML 3564

February 1, 2011 - July 23, 2018 - 622-05-25-30 ML3536

August 15, 2010 - January 31, 2011 - 622-05-25-30 - ML3398

 

Water Safety 622-05-25-30-02

April 1, 2022 - May 31, 2024 - 622-05-25-30-02 ML 3803

October 1, 2019 - May 31, 2022 - 622-05-25-30-02 ML 3677

 

 

Proper Storage of Medication, Alcohol and other Hazardous Material 622-05-25-30-03

April 1, 2022 - May 31, 2024 - 622-05-25-30-03 ML 3803

October 1, 2019 - May 31, 2022 - 622-05-25-30-03 ML 3677

 

 

Safe Sleep 622-05-25-30-05

April 1, 2022 - May 31, 2024 - 622-05-25-30-05 ML 3803

October 1, 2019 - May 31, 2022 - 622-05-25-30-05 ML 3677

August 15, 2010 - September 30, 2019 - 622-05-25-30-05 ML 3564

 

 

Child Restraints and Safety Belts 622-05-25-30-07

April 1, 2022 - May 31, 2024 - 622-05-25-30-07 ML 3803

October 1, 2019 - May 31, 2022 - 622-05-25-30-07 ML 3677

 

 

Water Temperature and Testing 622-05-25-30-10

April 1, 2022 - May 31, 2024 - 622-05-25-30-10 ML 3803

May 1, 2021 - May 31, 2022 - 622-05-25-30-10 ML 3677

October 1, 2019 - April 30, 2021 - 622-05-25-30-10 ML 3615

April 26, 2017 - September 30, 2019 - 622-05-25-30-10 ML 3564

August 15, 2010 - April 25, 2017 - 622-05-25-30-10 - ML3503

Name change 4/26/2017 from Water Supply to Water Testing

 

 

Fire Prevention and Safety 622-05-25-35

June 1, 2024 - September 30, 2024 - 622-05-25-35 ML 3867

April 1, 2022 - May, 31, 2024 - 622-05-25-35 ML 3803

October 1, 2019 - May 31, 2022 - 622-05-25-35 ML 3677

February 15, 2014 - September 30, 2019 - 622-05-25-35 ML 3564

August 15, 2010 - February 14, 2014 - 622-05-25-35 - ML3398

 

 

Personal Characteristics of Foster Care Providers 622-05-30

April 1, 2024 - March 31, 2025 - 622-05-30 ML 3904

April 1, 2022 - May 31, 2024 - 622-05-30 ML 3803

October 1, 2019 - May 31, 2022 - 622-05-30 ML 3677

February 15, 2015 - September 30, 2019 - 622-05-30 ML 3564

August 15, 2010 - February 14, 2014 - 622-05-30 - ML3398

 

 

Discipline 622-05-30-05-05

April 1, 2022 - May 31, 2024 - 622-05-30-05-05 ML 3803

October 1, 2019 - May 31, 2022 - 622-05-30-05-05 ML 3677

February 15, 2015 - September 30, 2019 - 622-05-30-05-05 ML 3564

August 15, 2010 - February 14, 2014 - 622-05-30-05-05 - ML3398

 

 

Child Neglect and Abuse Reports 622-05-35

April 1, 2024 - March 31, 2025 - 622-05-35 ML 3904

April 1, 2022 - May 31, 2024 - 622-05-35 ML 3803

October 1, 2019 - May 31, 2022 - 622-05-35 ML 3677

August 15, 2010 - September 30, 2019 - 622-05-35 ML 3564

 

 

Cooperation & Collaboration 622-05-40-05

April 1, 2022 - May 31, 2024 - 622-05-40-05 ML 3803

October 1, 2019 - May 31, 2022 - 622-05-40-05 ML 3677

August 15, 2010 - September 30, 2019 - 622-05-40-05 ML 3564

 

Life Books 622-05-40-25

REPEALED August 15, 2010 - May 31, 2022 - 622-05-40-25 ML 3677

There are no archives for this section.

 

 

Cooperation in Securing Services for the Child 622-05-40-30

REPEALED August 15, 2010 - May 31, 2022 - 622-05-40-30 ML 3677

There are no archives There are no archives for this section.

 

 

Involvement and Notice of Court Hearings 622-05-40-35

April 1, 2022 - May 31, 2024 - 622-05-40-35 ML 3803

October 1, 2019 - May 31, 2022 - 622-05-40-35 ML 3677

August 15, 2010 - September 30, 2019 - 622-05-40-35 ML 3564

 

 

Notice Regarding Participation in Court Hearings and Right to be Heard 622-05-40-40

REPEALED February 15, 2014 - May 31, 2022 - 622-05-40-40 ML 3677

New Title, Changed ML 3398/2/15/2014

August 15, 2010 - February 14, 2014 - 622-05-40-40 - ML 3398

 

 

Training Requirements 622-05-40-45

Renamed to 622-05-15-05

October 1, 2019 - May 31, 2022 - 622-05-40-45 ML 3677

February 15, 2014 - September 30, 2019 - 622-05-40-45 ML 3564

August 15, 2010 - February 14, 2014 - 622-05-40-45 - ML 3398

 

 

Tribal Affidavit Service Area 622-05-45-03

April 1, 2022 - May 31, 2024 - 622-05-45-03 ML 3803

May 1, 2021 - May 31, 2022 - 622-05-45-03 ML 3677

September 15, 2020 - April 30, 2021 - 622-05-45-03 ML 3615

 

 

Tribal Affidavit of Compliance - Licensing Approval 622-05-45-05

April 1, 2022 - May 31, 2024 - 622-05-45-05 ML 3803

September 15, 2020 - May 31, 2022 - 622-05-45-05 ML 3677

October 1, 2019 - September 14, 2020 - 622-05-45-05 ML 3593

April 26, 2017 - September 30, 2019 - 622-05-45-05 ML 3564

August 15, 2010 - April 25, 2017 - 622-05-45-05 - ML 3503

 

 

Tribal Affidavit Reimbursement 622-05-45-07

REPEALED September 15, 2020 - May 31, 2022 - 622-05-45-07 ML 3677

There are no archives for this section

 

 

Placement Preferences 622-05-45-10

April 1, 2022 - May 31, 2024 - 622-05-45-10 ML 3803

October 1, 2019 - May 31, 2022 - 622-05-45-10 ML 3677

August 15, 2010 - September 30, 2019 - 622-05-45-10 ML 3564

 

 

Roles and Responsibilities 622-05-50

April 1, 2022 - May 31, 2024 - 622-05-50 ML 3803

August 15, 2010 - May 31, 2022 - 622-05-50 ML 3677

 

 

 

Agency 622-05-50-05

REPEALED - Combined with 622-05-50 February 1, 2011 - May 31, 2022 - 622-05-50-05 ML 3677

August 15, 2010 - January 31, 2011 - 622-05-50-05 - ML3258

 

 

Foster Parent 622-05-50-10

REPEALED - Combined with 622-05-50 August 15, 2010 - May 31, 2022 - 622-05-50-10 ML 3677

There are no archives for this section.

 

 

Parents/Guardian 622-05-50-15

REPEALED August 15, 2010 - May 31, 2022 - 622-05-50-15 ML 3677

There are no archives for this section.

 

 

Child (when appropriate) 622-05-50-20

REPEALED August 15, 2010 - May 31, 2022 - 622-05-50-20 ML 3677

There are no archives for this section.

 

 

Denial or Revocation of License or Certification 622-05-55-05-30

April 1, 2022 - May 31, 2024 - 622-05-55-05-30 ML 3803 (New Title)

February 15, 2014 - May 31, 2022 - 622-05-55-05-30 ML 3677

New Title ML #3398/2/15/2014

August 15, 2010 - February 14, 2014 - 622-05-30 - ML 3398

 

 

Confidentiality 622-05-55-05-35

REPEALED August 15, 2010 - May 31, 2022 - 622-05-55-05-35 ML 3677

There are no archives for this section.

 

 

Motor Vehicle Operation by Youth in Foster Care 622-05-60

April 1, 2022 - May 31, 2024 - 622-05-60 ML 3803

July 24, 2018 - May 31, 2022 - 622-05-60 ML 3677

August 15, 2010 - July 23, 2018 - 622-05-60 ML 3536

 

 

Notice/Acknowledgment (Foster Parents) of Receipt of Information Related to Operation of Motor Vehicles by Youth in Foster Care, DN 310 622-05-60-05

REPEALED - Moved to 622-05-60 February 15, 2014 - May 31, 2022 - 622-05-60-05 ML 3677

August 15, 2010 - February 14, 2014 - 622-05-60-05 - ML 3398

 

 

Foster Care Provider Direct Deposit 622-05-65

April 1, 2022 - May 31, 2022 - 622-05-65 ML 3803

October 1, 2019 - May 31, 2022 - 622-05-60-05 ML 3677

February 15, 2014 - September 30, 2019 - 622-05-60-05 ML 3564