State Forms

Below are the typical list of forms used by the AAP. Some of the forms listed below are not provided to FCE but all forms are maintained in the AAP SW file or service file.

The current version of the below forms must be used. The FC EWs and the post-adoption SWs will check monthly for updated forms and notify staff. The FC EWs or the post-adoption SWs must be notified when the FC EW receives an outdated form.

AAP 1 - Request for Adoption Assistance Program Benefits:

The AAP 1 form is to be completed and signed by the adoptive parent/s. This form is to be submitted to SSA when determining the child’s eligibility. This form is maintained in the SW service file.

AAP 2 - Payment Instructions Adoption Assistance Program:

The AAP 2 is to be completed by the adoption SW upon the signing of the AAP agreement (AD 4320). This form states the payment of the AAP benefits and is to be submitted to the FCE for payment. The AAP 2 is submitted each time a payment is changed.

AAP 3 - Reassessment Information - Adoption Assistance Program

FCE will send the AAP 3 every two years to the adoptive parent. It is the adoptive parent’s responsibility to complete and return the AAP 3 to the post-adoptions services unit. If the AAP 3 not returned, there are no negative actions. AAP benefits must continue.

AAP 4 - Eligibility Certification Adoption Assistance Program

The AAP 4 documents the child’s eligibility and is completed by the adoption SW and FC EW. The FC EW must forward the document completed, signed, and dated AAP 4 to the post-adoption SW unit.

Reminder: Effective July 1, 2024, the age requirement for an applicable child will be any age. Until the California Department of Social Services updates the AAP 4 (rev. 4.22), the SW will disregard the non-applicable child pathway.

AAP 6 - Adoption Assistance Program Negotiated Benefits Amount and Approval Instructions and Form

The forms is required to be completed by the adoption SW when negotiating initial and subsequent AAP rates and benefits. This document in maintained in the SW AAP service file and not sent to FCE.

AAP 7 - Adoption Assistance Program Statement of Acknowledgement

The AAP 7 is used to advise the adoptive parent/s of potential federal and state tax credits. The AAP 7 is maintained the SW service file and not sent to FCE.

AAP 8 Adoption Assistance Program Nonrecurring Adoption Expense Agreement

The AAP 8 is used to submit reimbursement for a one time only nonrecurring adoption expense. The claim is usually submitted during the AAP negotiation and is completed by the adoption SW and submitted directly to fiscal for payment. This document is normally maintained in the AAP service file. With the implementation of the Department of Social Service Region office located in Oakland (see Adoption Assistance Program Aid Codes) this form may be sent to the FC EWs for payment.

This expense may be claimed even when the AAP benefits are not approved. The prospective/adoptive parent(s) have two years from the date of finalization to request reimbursement.

AD 4320 Adoption Assistance Program Agreement

The AD 4320 is an agreement of the negotiated AAP rate between the adoption agency and the adoptive parent/s. The AD 4320 must reflect the most currently agreed-upon rate, which may include SCIs, DAR, out-of-home placements, and Wraparound Services. The AD 4320 is maintained in the AAP SW file and is only needed by eligibility when an ICAMA is processed.

AD 513 (NMD) Non-Minor Adoption Mutual Disclosure Agreement

The signing of this form by the NMD, the Guardian Ad Litem, and the adoption SW or PO is necessary to participate in the NMD adoption program.

FC 8 Federal Eligibility Certification For Adoption Assistant Program

The Continuing FC EW must complete the FC 8 to determine federal or state eligibility for AAP benefits. It is completed when the EW is notified that the adoption is pending or at the finalization stage. The completed, signed, and dated FC 8 must be submitted to the Adoption Finalization SW along with the “Adoption Pending Finalization Rate Verification” form (SCD 2446). The FC 8 must also be Imaged in the case file.

Notes:

Effective July 1, 2024, the age requirement for an applicable child will be any age. Until the FC 8 (rev. 5.22) is updated, the EW will complete the form as per the current process with the following exceptions:
Under the first part of “Title IV-E Eligibility Pathway Applicable Child Pathway,” only statement a will be completed.
There is no change to completing the second part of this section (questions 1-4).
The worker must add the federal fiscal year to the signature date field at the bottom of page 3.

2021 AAP Monitoring Findings Report

Per the 2021 AAP Monitoring Findings Report, the FC 8 must be completed within the same federal fiscal year (FFY) as the adoption was finalized. The FFY begins October 1st and ends September 30th. For example, FFY 2022 began 10/1/21 and ends on 9/30/22.
Effective immediately, when PAS receives a FC 8 form that was completed in a different FFY than which the adoption was finalized, the Social Worker will send the form back to the EW to have the date revised within the same FFY of adoption finalization. Assuming the information on the original FC 8 is correct, the only difference on the revised form will be the date of the EW’s signature.

For example, on the original FC 8, the EW will cross out the original signature date, add the current date, and initial the item.
The EW must then remove the original FC 8 form from Imaging and scan the revised FC 8 to Imaging. The worker must complete the “IDM DEBS Document Properties Change Request” form SCD 183 and submit it to Clerical to remove the original document.

The RDSS office will request that the FC 8 and the AAP 4 be completed when the adoption is pending finalization. For RDSS, refer to Oakland Regional Office of the Department of Social Services Adoption Service Bureau EAS 35325.

FC 10 Income and Property Checklist

The FC 10 is used only when determining AFDC eligibility in the home of removal; however, it only applies to one of the non-applicable child Title IV-E eligibility pathways. The FC 8 is sufficient documentation to support the completion of the AAP 4. The FC 10 does not apply to all AAP eligibility pathways and is only used for children not eligible for federal AAP benefits.