HomeMy WebLinkAbout20051170.tiff RESOLUTION
RE: APPROVE REVISIONS TO OPERATIONS MANUAL, SECTION 2.000, SOCIAL
SERVICES DIVISION POLICIES AND PROCEDURES
WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
WHEREAS,the Board has been presented with revisions to Section 2.000,Social Services
Division Policies and Procedures,for the Department of Social Services Operations Manual, and
WHEREAS,after review,the Board deems it advisable to approve said revisions,a copy of
which is attached hereto and incorporated herein by reference.
NOW,THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld
County, Colorado, ex-officio Board of Social Services,that the revisions to Section 2.000, Social
Services Division Policies and Procedures for the Department of Social Services Operations
Manual, be, and hereby are, approved.
The above and foregoing Resolution was,on motion duly made and seconded,adopted by
the following vote on the 11th day of April, A.D., 2005.
BOARD OF COUNTY COMMISSIONERS
!� WELD COUNTY, COLORADO
•
William H. J e, Chair
C. Clerk to the Board
861 et."
M. J. eile,Pro"Tem
� Clerk to the Board EXCUSED
David E. Long
AP D AS T • EXCUSED
Robert D. Masde
ounty Attorney Glenn
V a*' V� 4-
Glenn Vaad
Date of signature: 47
2005-1170
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DEPARTMENT OF SOCIAL SERVICES
P.O. BOX A
GREELEY, CO. 80632
Website; www.co.weld.co.us
Administration and Public Assistance(970)352-1551
MEMORANDUM Child Support(970)352-6933
TO: William H. Jerke, Chair Date: April 4, 2005
Board of County Commissioners
•
COLORADO FR: Judy A. Griego, Director, Social Services. //61,014, Ci 4.,(
RE: Revisions to Section 2.000, Social Serviceshivision
Policies and Procedures, Weld County Department of
Social Services Operations Manual
Enclosed for Board approval are revisions to Section 2.000, Social Services Division Policies and
Procedures, Weld County Department of Social Services Operations Manual. These revisions
were reviewed at the Board's Work Session held on January 24, 2005, and April 4, 2005.
The purposes of the revisions are to:
Clarify certain adoption policies and procedures as requested by the Colorado
Department of Human Services. Those revisions that are being clarified include:
A. Section 2.322, Special Needs Rates for Developmentally Disabled and
Physically Disabled, A. 1. a, and E. The Department included in its definition
of"developmentally disabled" the notation that these children are eligible to
received services through the local Community Center Board and clarified that
the Depaiknent's Placement Review Committee must approve the service
payment level for each child.
B. Section 2.324, Subsidized Adoption Reimbursement,A. The Department
reiterated its policies regarding how subsidized adoption subsidies are
determined in this section and referenced sections regarding respite care and
consideration of the special needs care.
C. Revision to Adoption Forms. The Department labeled each form used for
adoption purposes.
2. Conform to recent State Law and State rule changes regarding Institutional Abuse
Investigations. Section 2.101.31,Procedures for Investigating Institutional Abuse
Allegations,states that a supervisor must provide written approval in Trails (State
computerized system) when it is determined that there is an investigative need to notify
parents or legal guardians of uninvolved children that there is a child abuse or neglect
investigation. This written approval will include the determination of the severity of the
abuse or neglect and the reasons of why such notification is essential to the investigation
and safety of the children in the care of the facility.
If you have any questions, please telephone me at extension 6510.
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2.322 Special Needs Rates for Developmentally Disabled and Physically Disabled
Effective 1/1/99 A. The Department may consider the additional needs of the child to
Revised 1/05 determine which of the three additional rates is appropriate in accordance
with the following criteria:
1. A special needs rate for professional services shall be determined by
a physician that the child requires more than the normal amount of
care, treatment and training, due to developmental disabilities
and/or a serious physical disability.
a. As used above, the term "developmentally disabled" means
a child who is profoundly delayed up to and including the
trainable child and is eligible to receive services through the
local Community Center Board.
b. The term "physically disabled" means the child who puts
extra physical demands on foster parents; e.g., the child who
cannot walk without assistance or has to be lifted; the child
who has no bowel or bladder control, or must have extra
attention by the foster parents under the supervision of a
physician, etc.
Effective 1/1/99 B. Foster care parents may need relief in some cases to provide the necessary
24-hour care.
Effective 1/1/99 C. The developmentally disabled and physically disabled contract is reviewed
and renewed each 6 months when eligibility for foster care is redetermined.
Effective 1/1/99 D. At the time a child in need of a developmentally disabled or physically
disabled allowance is placed, the Department and the provider shall enter
into a contract (SS-22). The effective date of the contract is the date the
child is placed. The termination date of the contract is the next 6 month
review date. A new contract shall be signed at each 6 month review of the
child's need for foster care.
Effective 1/1/99 E. The Department's Placement Review Committee must approve the service
payment level for each child.
Revised 1/01/02 F. The amount of the payment for services, based on each child served and
Revised 6/20/02 extent of services needed, the daily payment of$3.12, $4.64, or$6.25 is
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Revised 8/5/02 entered in Section F of Form 5710.4. Table 2 will be used to calculate the
Revised 10/29/02 rate payment. The payment to the foster care provider will be the basic
Revised 12/03 maintenance rate for the child, according to his or her age, plus the Respite
Revised 12/04 Care allowance if the child is in a County Certified Foster Home or
Revised 1/05 Certified Kinship Home and the appropriate special needs rate.
Table 2
Daily
Professional Service Level
Level 1 Level 2 Level 3
$3.12 $4.64 $6.25
1. Based on the level of service required, as determined and
documented by a physician and approved by the Department's
Placement Review Committee.
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2.324 Subsidized Adoption Reimbursement
Revised 1/05
/05
The Department determines the amount and kind of subsidy based on the following:
1. The child's documented special needs at the time of the adoptive placement.
2. The adoptive family's circumstances.
3. The need to purchase services that are not available in the community free of
charge.
Revised 9/24/01 A. The maximum subsidized adoption reimbursement that the Department
Revised 6/03 will pay, in monetary reimbursement; to adoptive parents is the County
Revised 1/05 Certified Foster Care basic maintenance rate. (Referenced in Section
2.321.1)
Note: The monthly respite care payments that is provided under the foster
care program is not a benefit under the subsidy program. Once a monetary
child maintenance rate is established for a subsidy, this rate is not eligible
for cost of living increases.
The Department may consider the additional needs of the child to
determine if the Special Needs Rate for the Developmentally Disabled and
Physically disabled apply. (Referenced in Section 2.322)
B. Available public programs and insurance benefits for which the child is
eligible shall be used first to address the child's needs before subsidized
adoption payments are used.
C. In addition to the monetary reimbursement, paid to the adoptive parents as
an adoption subsidy, the Department may also purchase services on behalf
of the child. This assistance will include any assistance, excluding
Medicaid, intended to help, or remove barriers to, the adoption of children
with special needs. The Department will consider the monetary value of
these services when negotiating the amount it will pay, in monetary
reimbursement, to adoptive parents as an adoption subsidy. The services
that may be considered for this purpose include, but are not limited to:
1. Special Circumstances Child Care as described in Section 2.801
2. Core Services Program as described in Section 2.802
3. Case Services Reimbursement.
D. A special needs child is defined in Colorado Department of Human
Services, Volume VII, Section 7.203.22(E) and C.R.S. § 26-7-101(2).
E. Adoption subsidies will be reviewed every three years. The Department
may renegotiate the current rate at the time of each review. If it is
determined that there is no current need for a cash payment for a special
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WELD COUNTY SUBSIDIZED ADOPTION INFORMTION
WC-A-1 (4/03)
This document is intended to answer"Frequently Asked Questions" about Subsidized Adoption.
It is not intended to be a substitute for legal advice. If you have specific questions about an issue,
the caseworker or county negotiator may be able to explain further but it is recommended that you
seek legal advice from your own attorney if questions remain.
SUBSIDIZED ADOPTION
Colorado operates two subsidized adoption programs: The Title IV-E program (W-E) and the
state and county—only program. The federal government participates in adoption assistance
payments on behalf of children who meet the eligibility criteria for the Title IV-E program. The
state and county participate in adoption assistance payments on behalf of children who do not
qualify for the IV-E program. A child can only be eligible for one type of subsidy program. If a
child is eligible for the Title IV-E program, the child is considered ineligible for the state and
county—only program. Under the IV-E program, if a child is eligible, the state (through the county
department) is required to enter into an adoption assistance agreement with the adoptive parents of
a child with special needs (as defined in section 473(c) of the Foster Care Independence Act of
1999). All parties must sign this agreement before an adoption takes place. The adoptive parents
can waive the assistance but they must do so in writing. If an agreement cannot be reached
(including whether the child is IV-E eligible), the agency determines the amount of subsidy and
the adoptive parents are entitled to a"fair hearing" in front of an administrative law judge if they
continue to dispute the amount. There are time limits and other requirements for that appeal and
adoptive parents should consult with an attorney if they have questions.
Weld County DSS determines the amount and kind of subsidy based on the following:
1. The child's documented special needs at the time of the adoptive placement.
2. The adoptive family's circumstances.
3. The need to purchase services that are not available in the community free of charge.
ELIGIBILITY REQUIREMENTS
In order for a child to be eligible for subsidized adoption, all of the following factors must be present
at the time the child is placed for adoption:
1. The goal for the child is adoption and the court has determined that the child cannot or
should not be returned to the home of his/her parents and all parent-child legal relationships
are terminated.
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2. The county department, agency, or relative requesting the adoption subsidy is financially
responsible for the care of the child.
3. The county must determine that in each case a reasonable, but unsuccessful, effort to place
the child for adoption has been made before providing a subsidy, unless the best interests of
the child would not be served by such an effort.
4. Children who are in the custody of licensed non-profit private agencies or who are living
with relatives must meet federal IV-E eligibility requirements.
5. The child is one with"special needs."
a) Physical disability (such as hearing, vision, or physical impairment; neurological
conditions; disfiguring defects; and heart defects).
b) Mental retardation (such as developmental delay or disability, perceptual or
speech/language disability, or a metabolic disorder).
c) Developmental disability resulting in educational delays or significant learning
processing difficulties.
d) Educational disability,which qualifies for Section 504 of Rehabilitation Act of 1973 or
special educational services.
e) Emotional disturbance.
I) Hereditary factors that have been documented by a physician or psychologist.
g) High-risk children(such as HD/-positive,drug-exposed,or alcohol-exposed in utero).
h) Other conditions that act as a serious barrier to the child's adoption. Conditions may
include but are not limited to a healthy child over the age of seven or a sibling group
that should remain intact and medical conditions likely to require further treatment.
SUBSIDIZED ADOPTION SERVICES AVAILABLE
1. Medicaid— Children with an effective subsidized adoption agreement are eligible for
Medicaid.
2. Non-recurring Adoption Expenses—The department may reimburse the adoptive
parent(s) for expenses that are reasonable and necessary for the adoption to occur, subject
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to a maximum of$800.00. The expenses must;
a) directly relate to the legal adoption; and
b) not be in violation of state or federal law; and
c) not have been reimbursed from other sources of funds.
Reimbursement may only be requested after adoption finalization. The request for
reimbursement must be submitted within (1) year after the date of the finalization.
3. Adoption Assistance—The county department may authorize the following types of
adoption assistance subsidies:
A. Long-Term Subsidy (Available for IV-E and State/County subsidies)—To partially meet
the everyday needs of the child. The payment that is agreed upon should combine
with the parents' resources to cover the ordinary and special needs of the child.
The circumstances of the adopting parents must be considered together with the
needs of the child. However, families with the same incomes or circumstances
will not necessarily receive the same amount since each child is unique.
Termination or reduction in the amount is discussed below. Increases in the
payment may be considered by written request from the adoptive parent, when the
maintenance foster care rate is increased or; if the subsidy was not at the
maximum amount, there may be negotiated increases if documentation is
provided that the situation justifies it.
B. Time-Limited Subsidy (Available for State/County-only subsidies)—To partially meet
the everyday needs of the child for a specified period. These are start-up costs for
those things that children placed for adoption do not always have, such as
sufficient clothing or day care before a child is of school age. This subsidy
partially covers unmet needs that are time limited and non-renewable.
C. Dormant Subsidy(Available for State/County-only subsidies)—No adoption assistance is
provided at this time. Weld DSS will document special needs for the child in the
services record and in the automated system, that the potential need for a
financial subsidy exists and may need be activated at a future time.
Documentation will have to be provided before a dormant subsidy is activated.
4. Medical Subsidy
a) Medical subsidies are payments made directly to adoptive parents for a service
already received or to a vendor for treatment of physical or developmental
disabilities or an emotional disturbance. A medical subsidy shall relate directly to
the barrier or barriers identified at the time the initial subsidy is approved.
b) Medical subsidies are not available for treatment of any physical or developmental
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disability or emotional disturbance diagnosed after finalization of the adoption.
c) Medical subsidies may be used to supplement any other available resource such as
an adoptive family's private insurance that pays part but not all for the child's
treatment (physical, mental, and emotional).
d) Subsidized adoption payments for medical services shall reflect the reasonable
costs of those services in the child's community.
5. Reimbursable and Non-Reimbursable Subsidized Adoption Case Services— Case
Services are a type of purchased program services that support a case plan for children in a
subsidized adoption. Case services are provided to meet a child's special needs identified
when the child is placed for adoption and which are not covered by the adoption assistance
or Medicaid subsidies. The following are examples of reimbursable and non-
reimbursable expenses allowed under Case Services:
A. Medical
1) Orthodontia
a. Cosmetic reasons—not reimbursable.
b. Special needs directly related to the reason for which the child was classified as
special needs, e.g. cleft palate or injury related to an abuse will be
reimbursable.
2) Eye Glasses
Payment for eye glasses or contacts related to the child's special need's identified
at the time of the initial subsidized adoption agreement are reimbursable.
3) Medication
a. Routine that is not related to the child's special needs—not reimbursable.
b. If related to the child special needs—reimbursable. The medication must be
prescribed by a licensed physician and related to the special need identified at
the time the child was approved for subsidized adoption.
4) Special Therapies— Speech, Occupational, and Physical
If not available through other community and family resources—reimbursable.
School-age children should receive these services through the school system.
5) Special Equipment—Special medical need/equipment, as prescribed by a physician
may be reimbursable.
For severely physically challenged children, special exceptions should not exceed
$2,000 without supervisors written authorization.
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B. Psychological Services
1) Time-limited out-patient therapy for children living in states that do not accept
Medicaid for this service—reimbursable, if related to the child's special needs and
a written plan is obtained from the service provider which contains:
a. Diagnosis.
b. Prognosis.
c. Length of service.
d. Individuals who will be seen in therapy.
e. A cap on the amount of money to be spent for the psychological exam or
therapy.
f Frequency of contact (i.e., once a week, twice a month, etc.).
g. Type of therapy being provided (i.e. individual, group, family, etc.)
2) Day treatment- not reimbursable.
3) Residential Child Care Facility- not reimbursable.
4) In-patient psychiatric hospitalization- not reimbursable.
(Children who are Medicaid eligible may receive some in-patient psychiatric
services under the Medicaid Program.)
C. Educational Costs
1) Tutoring—not reimbursable.
School systems are mandated to provide all children with special needs a free
appropriate public education.
2) School tuition—not reimbursable.
There will be no reimbursement for tuition expenses through the adoption subsidy
program. If the family wants the child to remain in his/her current private school
placement, this is an expense for which they are responsible.
D. Respite and Day Care
1. Respite Care- reimbursable.
2. Day Care- Not reimbursable expect for IV-E children. If day care services are
needed and the child is IV-E eligible at the time of adoption, the family should be
referred for day care services, as they are eligible for Title XX services.
E. Other Subsidies
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A subsidy may be provided for a specified time to provide needed services, such as
transportation to facilitate adoptive placement.
TERMINATION OF A SUBSIDY
Weld County DSS will terminate adoption assistance payments for subsidized adoption when the:
1. Family requests payments end; or,
2. Child reaches age 18 or until age 21, if the county has determined that the child has
developmental or physical disability which warrants continuation of assistance; or,
3. Adoptive parents(s) are no longer legally responsible for the support of the child; or,
4. Child is not longer receiving any support from the adoptive family; or,
5. County of responsibility verifies the child's death, or marriage; or,
6. Child is removed from the adoptive home because of abuse or neglect.
CONTINUING SUBSIDIES BEYOND AGE EIGHTEEN
1. If a child is receiving a IV-E subsidy and is 18 years of age and has not graduated with a
high school equivalency, the county may continue the subsidy funded by State/County-only
until the child finishes high school or is 19 years of age. At 19 years of age, the subsidy
terminates regardless if the child is still in high school. Post-high school vocational
schools or college classes do not qualify for the continuance of a subsidy. The adoptive
parents shall provide documentation that the child is enrolled full-time in high school and
making progress in the program. Continuation of the subsidy may depend on available
county funds.
2. If a child is receiving a State/County-only subsidy and is 18 years of age and has not
graduated with a high school equivalency, the county may continue the subsidy until the
child finishes high school or is 19 years of age. At 19 years of age, the subsidy terminates
regardless if the child is still in high school. Post-high school vocational schools or college
classes do not qualify for the continuance of a subsidy. The adoptive parents shall provide
documentation that the child is enrolled full-time in high school and making progress in the
program. Continuation of the subsidy may depend on available county funds.
3. A child who is identified in the original subsidy agreement as being developmentally
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disabled or physically handicapped, is between the age of 18-21, and continues to live at
home, may continue to be eligible for the adoption assistance program.
REDUCTION OR DISCONTINUANCE OF ADOPTION SUBSIDY
1. If the adoptive parents are receiving state/county adoption assistance payments and the
child is placed into the custody of the Department for an out-of-home placement for a
duration of over 30 calendar days, the state/county adoption assistance payment will be
discontinued to the adoptive parents. The state/county adoption assistance payment will
not be reinstated to the adoptive parents because the child returns to the home of the
adoptive parents for holidays or visits while the child is in the custody of the Department.
A state/county subsidy can only be resumed when the child is returned home and the out-
of-home placement has been discontinued on the Department's automated reporting
system.
2. If the adoptive parents have an approved IV-E adoption assistance payment and the child is
placed into the custody of the Department for an out-of-home placement for a duration
longer than 30 calendar days, the department will assess a parental share fee not to exceed
the amount of the approved adoption assistance payment. The parental fee will not be
discontinued because the child returns to the home of the adoptive parents for holidays or
visits while the child is in the custody of the Department.
REVIEW OF ELIGIBILITY FOR ALL ONGOING SUBSIDIES
1. The county shall review the current subsidy agreement every three years. You will be
contacted by the department prior to the tri-annual due date. The subsidy renewal form,
along with proper documentation regarding current/ongoing special needs of the child must
be submitted to the department in order for the subsidy to continue. If a renewal is not
received prior to the tri-annual due date, please contact your current adoption caseworker
so that no disruption in the adoption subsidy will take place.
2. The adoptive family may request a review of the subsidy prior to the three-year review if
changes in the needs of the child or family circumstances occur.
3. Any changes in the subsidy, must be related to the needs of the child, which were identified
as the original barrier(s) to the adoption.
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RIGHT TO APPEAL
1. When the county department denies an application for adoption subsidy, or reduces or
terminates the subsidy grant, the applicant or recipient shall have a right to appeal and may
be represented by counsel. When either state or federal law requires or results in a
reduction or deletion of services, no hearing is required. See C.R.S. § 26-7-107 and Code
of Federal Regulations for more information.
2. Examples of issues which may be appealed:
A. Relevant facts regarding the child were known by Weld County DSS and were not
presented to the adoptive parents prior to finalization of the adoption.
B. Denial of assistance based on a means test of an adoptive family.
C. Disagreement with the determination on whether the state is eligible for adoption
assistance.
D. Failure to advise the adoptive parents that adoption assistance is available.
E. Decrease in the amount of adoptive assistance without the agreement of the adoptive
parents.
F. Denial of a request for change in payment level due to a change in the adoptive parents
circumstances.
3. When a family who has been denied Title IV-E Subsidized Adoption benefits requests a
state level Fair Hearing, it is the responsibility of the Administrative Law Judge to
determine whether the applicant or recipient was wrongly denied eligibility or whether the
amount of the subsidy was determined correctly. (See Section 7.203.24, C, for fair hearing
circumstances.)
The adoptive parents have the burden of proving extenuating circumstances and adoption
assistance eligibility at a state level Fair Hearing. The state or/its designee can provide
factual information to assist the family in establishing eligibility for Title IV-E Subsidized
Adoption.
4. A successful appeal can reverse the decision and if the child meets all eligibility criteria,
IV-E subsidies are available starting with the earliest date the child became eligible.
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Weld County Department of Social Services
Adoption Subsidy Information Acknowledgment
WC-A-2(4/03)
1. Adoption Expenses - (Check One) Eligible n Ineligible
Non-Recurring Adoption Expenses (applicable for initial agreement only). There is an
$800 ceiling for non-recurring adoption expenses for legal fees, and adoption fees.
2. Medicaid - (Check One) n Eligible n Ineligible
Type: Title IV-E Medicaid n State/County Only Medicaid n
4. Maintenance - (Check One) n Eligible n Ineligible
(Select one Adoption Assistance below)
Title IV-E Assistance n
A. Medicaid Only ❑
B. Long-Term (ongoing) $
Daily Rate: $
State/County Only Adoption Assistance Program n
A. Medicaid Only
B. Time-Limited - Number of years $
C. Long-Term (ongoing) $
D. Dormant: (Type Dormant on line) $
Dormant means, no adoption assistance payment is provided at this time; however,
due to the previously described special needs, there exists the potential need for
services. If there is a dormant financial subsidy, it will be reviewed as the child
ages or the family circumstance changes.
Daily Rate: $
5. Adoption Case Services Not applicable n One-Time n Ongoing
(Description)
6. Other(Description)
I/We do hereby acknowledge receipt of the following information on an adoption
subsidy and agree that we discussed an adoption subsidy with the county negotiator and
have AGREED /DISAGREED on the above information, relative to adopting
Adoptive Parent Signature Date Adoptive Parent Signature Date
County Negotiator Signature Date
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SPECIAL NEEDS ASSESSMENT WORKSHEET
FOR SUBSIDIZED ADOPTIONS
WC-A-3 (4/03)
1. BEHAVIOR MANAGEMENT - Does the child have emotional impairment and/or
behaviors which require special or extensive involvement by the adoptive parent(s) in
scheduling and monitoring of time and/or activities and/or crisis management?
If yes, please explain.
2. THERAPY/COUNSELING - Does the child attend therapy/counseling
sessions? If yes, what is the reason and how often does the child go?
3. EDUCATION - Does the child have any special educational requirements? If
yes, please explain.
4. PHYSICAL OR MEDICAL IMPAIRMENTS -Does the child have any physical or
medical impairments requiring daily medically prescribed therapy or procedures (i.e. daily
medication, etc.) If yes, please explain.
5. OTHER NEEDS TO CONSIDER - Does the child have any other special needs that
should be considered for adoption subsidy? If yes, please explain.
*** Please include professional documentation on questions answered "Yes". (i.e. letters
from doctors, therapist, etc.)
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ADOPTIVE FAMILY
RESOURCE
QUESTIONNAIRE
WC-A-4(12/04)
Adoptive child's name: Date:
Please complete the following questions regarding your family resources.
1) What is your family's gross monthly income?(Do not include foster or subsidy payments)$
2) Number of persons supported by that income:
3) Total of persons in home:
4)List additional financial sources and amounts available to members of the household(i.e. foster care,guardian
assistance, child support, social security, rental property,etc.):
Business Office Use Only
Current Foster Care Rate without respite:
Current Foster Care Rate with respite:
5)Does anyone in your family have unusual costs, such as medical or educational? _If yes,please explain:
6) What financial resources,other than your income,are available to meet the child's needs?
(Indicate amount by appropriate category)
$ SSD(disability of parent)include a copy of letter from Social Security Admin. (SSA)
$ SSA(survivor's/death of birth parent)include copy of the letter from SSA.
$ SSI (child's disability) include a copy of the letter from SSA.
$ Child Support(being received by adoptive family)
$ Other(Specify)
7)Will the child become eligible for additional benefits based on adoption by you? (Indicate kid of benefits and
amounts)
8)In thinking about the needs of this child and the resources(financial, extended family, community services,etc.)
available to your family,what will be REQUIRED in addition to those resources to continue support of this child in
your household? (If a monetary subsidy/or services are being requested please indicate the reason and
provide documentation for the request)Attach additional page of
needed.
9) Will the child being adopted be added to your medical insurance policy? Yes No
If yes,please complete the following:
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Effective Date of Child' Coverage:
Name of the Insurance Company:
Address(street, city,state,zip):
Name of Policy Holder:
Social Security Number:
Group/Plan#:
Policy ID#:
10)Attach a copy of your last tax return. (This is required information in order to complete the adoption.)
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REFUSAL OF ADOPTION SUBSIDY
I/We, do affirm that on this day
Name of Adoptive Parents Date
the Weld County Department of Social Services has informed me of the availability of an
adoption subsidy in the adoption of . I have
Child/Children's Name
conferred with my legal council and I do acknowledge that adoption subsidies are optional.
At this time, I am informing you of my refusal of any adoption subsidy that the Weld County
Department Social Services has advised me of.
Adoptive Parent Signature Date Adoptive Parent Signature Date
Notary Signature Date Department Signature Date
Notary Seal
My commission Expires:
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by the Intake Screener from such sources as the Department's computer
data base, case records, Central Registry, and CWSEST.
B. The caseworker, if one is currently assigned, and two child protection
managers shall review the case and all reports before a decision to
investigate or not investigate is decided by the two child protection
managers.
C. The review shall be documented in the file on the investigation summary
fonn. An Intake Manager is to ensure that the review and the
documentation have occurred and are appropriately documented.
2.101.3 Institutional Abuse Investigations
Revised 3/29/99 Institutional abuse or neglect is defined as abuse or neglect occurring in twenty-
four hour or day care settings. Investigations of institutional abuse allegations
will be conducted according to Volume VII.
2.101.31 Procedures for Investigating Institutional Abuse Allegations
Revised 3/29/99 A. Referrals regarding institutional abuse allegations will be screened
Revised 4/05 to determine whether they meet the criteria for investigation. All
institutional referrals that are assigned will be given a twenty-four hour
response time to investigate. Front Range Childcare Licensing is
responsible for day care licensing and will be notified by the caseworker as
part of the twenty-four hour response time on any investigations regarding
licensed childcare providers.
B. The caseworker will contact the reporting party for additional information.
C. The appropriate law enforcement agency will be notified if the allegation
involves any criminal violation.
D. The investigation will include an observation of, and an interview with the
alleged victim; any identified potential victims, witness, and staff
members. The investigating worker will review incident reports and any
other relevant documentation. The investigating worker will review any
prior child protection investigations on the facility. Parents of any alleged
victim will be notified of the allegations and interviewed regarding any
information they may have about the incident.
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Social Services Division Policies and Procedures
E. Parents or legal guardians of uninvolved children in less than 24 hour
licensed care setting shall be given notice of an investigation within 72
hours when it has been determined by the State or county department that:
1. The incident of alleged child abuse or neglect that prompted the
investigation is at the level of medium, sever, or fatal incident of
abuse or neglect, as defined by State rule at Sections 7.202.6, F.,
and 7.202.602, A., or involves sexual abuse;
2. The State Department or county department has made a
determination that notice to the parents or legal guardians of the
uninvolved children is essential to the investigation of the specific
allegation or its necessary for the safety of children cared for at the
facility;
3. The State Department or county department has documented in
writing the basis for the determination, and a state Department or
county department supervisor has provided written approval of the
determination for which basis and approval may be in electronic
form; and
4. The Manager of Institutional Investigations will be responsible to
provide written approval in Trails when it has been determined that
it is necessary to notify parents or legal guardians of uninvolved
children that there is a child abuse or neglect investigation. The
written approval will contain the determination for the severity
level of abuse or neglect; and the reasons notification is essential to
the investigation and safety of children cared for at the facility.
F. A report will be prepared documenting the investigation, and any
recommended corrective action to be taken by the facility. This report will
be distributed to the facility, the licensing authority for the facility, and the
State Institutional Abuse Review Team
G. When the caseworker enters a finding in Trails confirming abuse or
neglect in a day care center or home, the Front Range Childcare Licensing
Department will be notified within 24 hours of the finding.
Adm/manssl0.jag
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