Rule and Procedure Table of Contents


APPENDIX B FORMS USED WITH PROCEDURES 359

Payment Documents

Precondition Forms

CFS 315* Sibling Visitation Form

CFS 417 Referral Form for Psychological Evaluation

CFS 418 Level of Care Assessment Form

CFS 420-26 Attendance Exemption Request Form (Day Care)

CFS 438 Scholarship Program Student Application

CFS 470-A Adoption Assistance Program Child's Summary

CFS 470-B* Adoption Assistance Information and Application Form

CFS 470-C* Agreement for Adoption Assistance

CFS 470-D* Adoption Assistance Agreement Letter

CFS 497* Service Plan

CFS 888-3 Case Action Form

CFS 932C Infant Care Equipment Grant Application

CFS 932D Infant Care Equipment List

CFS 940-1 Referral for Purchase of Care for an Unmarried Mother

CFS 968-18 Day Care Provider Purchase of Service Contract

CFS 968-22 Program Plan Adoption Services

CFS 968-45 DCFS Contract Boilerplate

CFS 968-54 Performance Contract Reunification Budget Summary

CFS 968/Supp D Application for Subsidized Child Care

CFS 968/Supp E Day Care Program Plan narrative

CFS 968/Supp F Site-Administered Employment-Related Child Care Contract Exhibit

CFS 1410 Registration/Case Opening

CFS 1411 Eligibility I (Financial Data Sheet)

CFS 1429 DCFS Residential Placement Review Form

CFS 2000 Request for Child Care Service and Registration

CFS 2002* Foster Parent Application for Employment-Related Day Care

CFS 2003 On-Site Visit - License Exempt Day Care


Payment Documents

 

CFS 402 Request for Vital Record Verification

CFS 420-21a Day Care Monthly Enrollment Report

CFS 420-21b Monthly Enrollment Report

CFS 901 Claim Voucher - Agency

CFS 902 Exceptional Payment Requests

CFS 906 Placement/Payment Authorization Form (Department Foster Care)

CFS 906-1 Placement/Payment Authorization Form (Private Agency, Institution & G. H.)

CFS 906-4 Special Service Fee and Payment Extension Form

CFS 932 Purchase Authorization

CFS 1042 Billing Summary

CFS 1042F Family Preservation and Reunification Billing Summary

CFS 1042N Norman Emergency Assistance Billing Summary

C-10 Travel Voucher

C-13 Invoice Voucher

Rule and Procedure Table of Contents