Required Documents

 Certain requirements must be met to pay the provider. The following documents must be included in the foster care eligibility folder:

  • "Interstate Compact on the Placement of Children - Request" form (ICPC 100A)
  • "Interstate Compact on the Placement of Children - Report on Child's  Placement Status" form (ICPC 100B)
  • ICPC Memo from the DFCS ICPC Coordinator
  • A new "Foster Child's Data Record and  AFDC-FC Certification" form (SOC 158A) indicating the new placement
  • Written proof that the home meets the host state licensing or approval requirements.

Note: The FC EW is to request a copy of the home license for the eligibility case folder from the placing SW or DFCS ICPC Coordinator. 

 

In addition to the above documents, cases may include the following:

  • Verification of court or other authority to place a child as follows
    • Current or prior order which contains the required three findings
    • Public agency/dependent child placement court orders.
  • The current placement history
  • Case plan/permanency plan
  • Financial and medical plan
  • "Statement of Facts Supporting Eligibility for AFDC - Foster Care" form (FC 2) or “Statement of Facts Supporting Eligibility For The Approved Relative Caregiver Funding Option Program” form (ARC 1) or “Statement of Facts Supporting Eligibility for AFDC - EFC” form (FC2NM)
  • “Application and Statement to Facts for Child Not Living with a Parent or Relative and for Whom a Public Agency is Assuming Some Financial Responsibility” form (MC 250A)
  • “Statement of Citizenship, Alienage and Immigration Status” form (MC 13) (only when the child is not a US citizen)
  • "Federal Medicaid (Title IV-E) Eligibility/Ineligibility and Medical/Financial Plan" form (SCD 692)
  • "Sworn Statement of the Caretaker Relative to Establish Relationship" form (SCD 1383) (Required for Relatives)
  • "Out of State/County Request for Information" form (SCD 2213).

Related Topics

Out-of-State (OOS) Placements