Section 5, Chapter 1 (Case Records and Filing), Subsection 3 – Adoption/Guardianship Subsidy File

Effective Date:  5-1-19


This file is to contain family adoption/guardianship subsidy information and should be created for the adoptive or guardian family at the time of their first adoption/guardianship involving subsidy. As the family adopts or receives guardianship of more children, the new child(ren)’s information is to be added to this file.  This is to be a separate file used by the Children’s Service Worker managing the subsidy.  Any information post-adoption/guardianship should be placed in this file.  Contents of this file are to include the Child’s Placement summary, any reports for the child, the family’s home assessment and updates, forms, payment related paperwork, legal paperwork, the subsidy contract, and any correspondence.  Narrative that relates to the family should be entered in FACES.  The following sections are to be a part of this file:

Child Assessment – (Cover Sheet: White)

  • Child placement summary signed by the worker and family
  • Reports on the child

Family Assessment – (Cover Sheet: White)

  • Home Assessment
  • Updates

Forms – (Cover Sheet: Yellow)

  • Vendor Licensure/ Approval and Renewal screen in FACES
  • ICAMA forms
  • Third Party Resource Form (TPL-1) and Accident Reporting Form (TPL-2)
  • Release of Medical/Health Information (SS-6)

Payment – (Cover Sheet: Green – to be retained for at least one (1) year. If needed, the computer system retains this information and can be obtained.)

  • Service Authorizations
  • Payment Requests
  • Receipts

Legal – (Cover Sheet: Buff/Tan)

  • In Legal Guardianship Cases – Proof of Children’s Division Custody
  • Court orders:
  • Release of Jurisdiction (Adoption only)
  • Adoption Petition (if the worker receives one)
  • Transfer of custody order
  • Adoption decree
  • Award of Legal Guardianship

Subsidy Contract – (Cover Sheet: Pink)

  • Adoption and Guardianship subsidy forms

Narrative – (Cover Sheet: Blue)

  • Case contacts and summaries

Correspondence – (Cover Sheet: White)

  • Annual review letter
  • Fair hearing review letter
  • Any other written correspondence

Adopted Adult Information Request – (Cover Sheet: White)

  • Documents in this section include information regarding adopted adults, biological siblings, biological parents, and lineal descendants of the adopted adult.
  • Non-Identifying Information Form (CS-50)
  • Court order or request from court
  • Narrative pertaining to request
  • Court report
  • Correspondence
  • Documents including but not limited to:
  • Birth certificate
  • Death certificate
  • Driver’s license or photo I.D.
  • Adoption decree