Foster Care Forms

26.2 - SAWS 2 — Statement of Facts Supporting Eligibility

The SAWS 2/FC 2 obtains information about general AFDC-FC requirements (e.g., age, property, citizenship, SSN, income, services).
The SAWS 2 must be completed at the time of application by the Parent (Voluntary Placement) or the Legal Guardian
The FC 2 may be completed by the Placement Worker at application when the Parent is not available or not cooperating.

Note: At intake the Parent or Legal Guardian must complete a SAWS 2 and may NOT complete a FC 2. When dependency has been dismissed, the legal guardian must cooperate.

The FC 2 may be used at all renewals.

26.3 - FC 3 — Determination of Federal AFDC-FC Eligibility Linkage Worksheet

The FC 3 is completed by the Eligibility Worker to determine if the child meets all of the Federal AFDC-FC Program requirements.

26.4 - FC 3 A — AFDC-FG/U Worksheet

The FC 3 A form is the “AFDC-FG/U Linkage Worksheet”, it is used to determine if the child would have received AFDC-FG/U in the month of petition and the months prior to petition.

26.5 - FC 4 — Foster Care Program Choice Indicator

The FC 4 has historically been a required form to advise relatives of their funding options. The CDSS has determined the form is no longer necessary due to the changes in law over the last several years that has provided equitable funding options for relatives (such as ARC and Emergency Caregiver). ACIN I-23-22 announced that the FC 4 form is now obsolete.

26.6 - SOC 158 Foster Child's Data Record and AFDC-FC Certification

New Application or Reinvestigation

Placement Worker: (PO or SW)
1. Initiates SOC 158 and completes all of the following entries:
  1. Intake: A-2, C1-5, D1-9, E1-4, F1-3, G1-3, H1-5, I1-3, J1-2, K-1-4, L1, Signature and Date
    1. Note: Initial assessment is always due within 30 days from the petition date.
  2. RRR: A-2, C1-5, D1-9, E1-4, F1-3, G1-3, H1-5, I1-3, J1-2, K-1-4, L1-7, O1 (Relative NREFM Approval only) Signature and Date
    1. Note: For RRR the assesment must always be no more than 6 months apart.
2. Places original and first copy together with SAWS 1, FC 2, and SC 41 into PAC in-basket. (Petition/Detention may or may not be attached.)
3. Files bottom copy in services (JPD/Shelter) case record.
Foster Care Clerk/PAC:
1. For Intake assigns new cases to EW.
2. For Intake adds to Control Log.
3. Intake/RRR places packet in EW's “In” basket.
Eligibility Worker:
1. Reviews packet for completeness.
2. Reviews SOC 158 for completeness.
  1. Note: EW does not make entries on the SOC 158. If anything needs to be changed the EW has to advise the PO/SW.
3. Determines AFDC-FC eligibility.
4. Initials and dates bottom of form.
5. Files copy in case record.
6. If original and one copy of SOC 158 were both received from JPD, documents case number, worker number, signs and dates original SOC 158 and returns to JPD.”
7. Completes balance of intake/RRR procedure.
PTT Clerk:
1. Collects SOC 158.
2. Reviews SOC 158 for acceptability.
3. Makes changes on CWS/CMS system.

26.7 - SOC 158 Foster Child's Data Record and AFDC-FC Certification Placement Change

Placement/Emergency Satellite Home Worker:
1. Reports “change in placement” to EW by changing the following fields on the SOC 158 in the case file:
  1. SOC 158
  2. A-1
  3. F-1 - 8
  4. G-1 - 3
  5. H-1 - 5
  6. I-1 - 3
  7. J- 1 - 2
  8. K- 1-4
2. Signs and dates SOC 158.
3. Places original and first copy in PTT pick-up basket or routes the first copy to EW.
4. Files bottom copy in services case record.
PTT Clerk
1. Inputs changes to CWS/CMS system.

26.8 - SOC 369 — Agency-Relative Foster Parent Financial Disclosure (Kin-GAP)

The Social Worker must complete the SOC 369 for all cases where the relative foster parent is considering changing status to become a legal guardian. The payment information must be obtained from the Eligibility Worker. The relative foster mother and father must sign the SOC 369, and be given a copy, PRIOR to a status change. If necessary, the written statement shall be translated into the language spoken by the foster parent

26.9 - RFA 05A— Resource Family Approval Certificate

The RFA 05A is the form utilized by the State to verify that a home is an “Approved Home.” The Social Worker must provide the RFA 05A for all foster care placements. The RFA 05A must also remain in the service case file.

26.10 - RFA 06— Approval Update

The Social Worker must provide the RFA 06 on an annual basis and/or when a change occurs with the caregiver. The RFA 05A must also remain in the service case file.

26.11 - CA 30 — AFDC Budget Worksheet

A CA 30 is the budget computation for aid payment.

26.11.1 A CA 30 must be completed:

At time of initial payment.
At each RRR.
At any time there is a change in:
- Placement, and/or
- Rate
When issuing or deleting a special need.
When issuing a clothing allowance.
For corrections, to reflect overpayments or underpayments.
Upon receipt of a notice of lump sum payment to compute the period of ineligibility.

26.11.2 Minimum Requirements for Completion of a CA 30

In an effort to reach a goal of uniformity, the following MINIMUM REQUIREMENTS for completion of a CA 30 are required

Case Name
Case Number including FBU
Worker Number
Payment Month
Aid type on first adult line
Name of placement on second adult line
Child's name and check appropriate (recipient, fed/state) boxes under children.
Rate (per day, per month, etc. plus special care and supervision if applicable).
Remaining fields necessary to show correct calculation.

Note: If Social Services Agency is the payee, this income is to be considered for the neediness test only. The EW should document the neediness test in the “Comments” section.