Adoptions
ADP 196
ADP 196 Affidavit of Consent to Adoption #1, 1 page, 71 KB
ADP 197
ADP 197 Affidavit of Consent to Adoption #2, 1 page, 91 KB
CW 13
CW 13 HIPPA Notice of Privacy Practices, 3 pages, 47 KB
FC 0-16
FC 0-16 Foster to Adopt 74 Agreement, 3 pages, 93 KB
FORM 24
FORM 24 Special Services Adoption Assistance Agreement, 1 page, 49 KB
FORM 28
FORM 28 is no longer required and has been removed.
Non-Compliance with Verification Requirements Termination Notice
Microsoft Word Format, 45KB
Adoption Assistance Review Guide
Microsoft Excel Format, 47KB
FC 29
FC 29 Foster Parent Child Safety Agreement, 2 pages, 50 KB
Adoption Assistance Review Guide Instructions
Microsoft Word Format, 35 KB
Adoption Assistance Repayment Agreement
Repayment agreement used for over payment of Adoption Assistance funds.
Microsoft Word Format, 65KB
Foster Home Conversion Referral Form
Microsoft Word Document, 542 KB
Adoption Assistance Eligiblility Letter for Children 18 and Over
Microsoft Word Format, 44KB
30 Day Termination Notice of Adoption Assistance Benefits
Microsoft Word Format, 48KB
FORM 31
FORM 31 Placement Origin, 1 page, 36 KB
FORM 33
FORM 33 Placement Agreement (Single Child), 1 page, 38 KB
FORM 35
Form 35 - Application for Adoption, 2 Pages, 131 KB
FORM 35 (SP)
Spanish Version of Form 35, 120 KB
FORM 36
FORM 36 Medical Report, 3 pages, 97 KB
FORM 36 (SP)
Spanish Version of Form 36, 99 KB
FORM 37
FORM 37 Placement Agreement (Siblings), 1 page, 37 KB
FORM 43
FORM 43 Affidavit of Disclosure, 2 pages, 78 KB
FORM 44
FORM 44 Financial Statement, 2 pages, 63 KB
FORM 44 (SP)
Spanish Version of Form 44, 135 KB
FORM 67
FORM 67 Purchase of Service Foster Home Conversion, 2 pages, 103 KB
CW 100
CW 100 PUP/Homestead/Parent Aide Authorization, 2 pages, 92 KB
CW 101
CW 101 PUP/Homestead/Parent Aide Cumulative Record, 2 pages, 95 KB
FC 149
FC 149 Notification to Foster Parents of Intent To Petition For TPR, 1 page, 45 KB
FC 149I (Instructions)
FC 149I Notification to Foster Parents of Intent To Petition For TPR Instructions, 1 page, 22 KB
FC 150
FC 150 Foster Parents Affidavit For Consideration of Adopting Foster Child Currently in Home, 2 pages, 73 KB
FC 150I (Instructions)
FC 150I Foster Parents Affidavit For Consideration of Adopting Foster Child Currently in Home Instructions, 1 page, 22 KB
FC 151
FC 151 Foster Parents Notification of Decision Regarding Adopting Foster Child Currently in Home, 1 page, 50 KB
FC 151I (Instructions)
FC 151I Foster Parents Notification of Decision Regarding Adopting Foster Child Currently in Home Instructions, 1 page, 26 KB
FC 223
FC 223 Medicaid and IV-E Application for Foster Care, 1 page, 74 KB
FC 223I (Instructions)
FC 223 Instructions. Microsoft Word format, 26KB.
FC 224
FC 224 Removal Home Income and Asset Checklist, 1 page, 55 KB
FC 224I (Instructions)
FC 224 Instructions. Adobe Acrobat format, 26KB.
FC 227
FC 227 Notification of Change in IV-E Status, 1 page, 49 KB
FC 271
FC 271 Placement of Non-Special Needs Child, 1 page, 48 KB
CPS 388
CPS 388 Goals and Steps, 2 pages, 46 KB
FORM 399
FORM 399 Verification of Receipt of Information Regarding Post, 1 page, 39 KB
FORM 400
FORM 400 Child Registration, 2 pages, 162 KB
FORM 400I (Instructions)
FORM 400I Child Registration Instructions, 1 page, 49 KB
FORM 401
FORM 401 Family Registration, 2 pages, 141 KB
Promotional Items Request Form
Microsoft Word format, 54.5 KB
FORM 401I (Instructions)
FORM 401I Family Registration Instructions, 1 page, 49 KB
FORM 402
Call the Adoption Assistance Unit at 404-657-3585 for assistance
FORM 402A
FORM 402A Non-Recurring Expenses Adoption Assistance Agreement, 8 page, 206 KB Updated 6/2009
FORM 403
FORM 403 Adoption Assistance Memorandum, 2 pages, 152 KB
FORM 404
FORM 404 Consent For Criminal Records Check, 1 page, 34 KB
FORM 405
FORM 405 Purchase of Service Agreement - Placement, 2 pages, 39 KB
FORM 409
FORM 409 Name Change Following Adoption, 1 page, 35 KB
FORM 413
FORM 413 Background Non-State Agency Child, 7 pages, 600 KB
FORM 414
FORM 414 Placement Letter, 1 page, 43 KB
FORM 419
FORM 419 Background Information State Agency Child, 7 pages, 599 KB
FORM 419 (SP)
Spanish Version of Form 419, 120 KB
FORM 432
FORM 432 Child's Life History Checklist/Registration Cover Letter, 1 page, 140 KB
CPS 450
CPS 450 Basic Information Worksheet, 2 pages, 149 KB
CW 510
CW 510 - Legal Services Request Report , 1 page, 35 KB
FORM 553
FORM 553 Biological Parent Affidavit of Non-Disclosure, 1 page, 60 KB
FORM 553 (SP)
Spanish Version of Form 553, 54 KB
FORM 560
FORM 560 Adoption Assistance Fact Sheet, 1 page, 28 KB
FORM 561
FORM 561 Biological Parent Consent To Contact, 1 page, 78 KB
FORM 561 (SP)
Spanish Version of Form 561, 69.5 KB
FORM 572
FORM 572 Surrender (Biological not Legal Father), 1 page, 39 KB
FORM 572 (SP)
Spanish Version of Form 572, 36.5 KB
FORM 572I (Instructions)
FORM 572I Surrender (Biological not Legal Father) Instructions, 1 page, 22 KB
FORM 573
FORM 573 Surrender (Parent), 1 page, 36 KB
FORM 573 (SP)
Spanish Version of Form 573, 36.5 KB
FORM 573I (Instructions)
FORM 573I Surrender (Parent) Instructions, 1 page, 22 KB
FORM 574
FORM 574 Grandparent Acknowledgement, 2 pages, 50 KB
FORM 574I (Instructions)
FORM 574I Grandparent Acknowledgement Instructions, 1 page, 24 KB
FORM 576
FORM 576 Affidavit of Department Representative, 1 page, 36 KB
FORM 576 (SP)
Spanish Version of Form 576, 39 KB
FORM 576I (Instructions)
FORM 576I Affidavit of Department Representative Instructions, 1 page, 22 KB
FORM 577
FORM 577 Acknowledgement of Surrender, 1 page, 36 KB
FORM 577 (SP)
Spanish Version of Form 577, 31.5 KB
FORM 577I (Instructions)
FORM 577I Acknowledgement of Surrender Instructions, 1 page, 21 KB
FORM 578
FORM 578 Mother's Affidavit, 4 pages, 131 KB
FORM 578 (SP)
Spanish Version of Form 578, 145 KB
FORM 578I (Instructions)
FORM 578I Mother's Affidavit Instructions, 1 page, 22 KB
FORM 579
FORM 579 Adoptive Mother's Affidavit, 2 pages, 105 KB
FORM 579I (Instructions)
FORM 579I Adoptive Motherss Affidavit Instructions, 1 page, 21 KB
FORM 580
FORM 580 Denial/Disclaimer/Surrender, 1 page, 40 KB
FORM 580I (Instructions)
FORM 580I Denial/Disclaimer/Surrender of Rights Final Release for Adoption Instructions, 1 page, 21 KB
FORM 580 (SP)
Spanish Version of Form 580, 36.5 KB
FORM 581
FORM 581 Withdrawal of Surrender, 1 page, 34 KB
FORM 581I (Instructions)
FORM 581I Withdrawal of Surrender Instructions, 1 page, 20 KB
CW 713
CW 713 - Inter-Office, 2 pages, 88 KB
FORM 5459R
FORM 5459R Authorization For Release of Information, 100 KB
FORM 5459R (SP)
Spanish Version of Form 5459R, 97.5 KB
FORM 5459RI (Instructions)
FORM 5459R Authorization For Release of Information Instructions, 11 pages, 119 KB
FORM 6036
FORM 6036 Family Approval/Registration Cover Letter, 2 pages, 66 KB
FORM 6036I (Instructions)
FORM 6036I Family Approval/Registration Cover Letter Instructions, 1 page, 22 KB
Child Life History Narrative
Microsoft Word format, 39KB.
Relative Care Assessment
Microsoft Word format, 35KB.
Child Life History Referral Form
Microsoft Word Format, 526KB
Crisis Intervention / Consent Form
Microsoft Word Format, 33KB
Resource Family Home Evaluation
Microsoft Word format, 93KB.
My Turn Now Check Request
My Turn Now Check Request, 1page, 24 KB
My Turn Now Descriptive Summary
My Turn Now Descriptive Summary, 3 pages, 67 KB
FORM 535
FORM 535 Authorization and Claim for Psychological, Psychiatric and Speech Therapy Services , 3 pages, 94 KB
Adoption Notice of Privacy Practices (SP)
Spanish Version of Adoption Notice of Privacy
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