Rule 5101:2-49-17 | Case record requirements for Title IV-E adoption assistance (AA).
(A) The public children services agency (PCSA) is to maintain a separate case record for each AA case.
(B) The case record is to contain documentation which supports the PCSA's actions in determining eligibility for AA. The case record is to include the following information, when applicable:
(1) A copy of the completed and signed JFS 01451 "Title IV-E Adoption Assistance Application."
(2) A copy of the AA eligibility determination in Ohio comprehensive child welfare information system (Ohio CCWIS).
(3) A copy of each signed JFS 01451-B "Title IV-E Adoption Assistance Annual Assurance of Legal Responsibility, School Attendance and Eligibility for Continued Medicaid Coverage."
(4) A copy of the PCSA's petition to the court which led to the child's removal from the specified relative.
(5) A copy of the court order which resulted in the child's removal from a specified relative, and which contains a judicial determination to the effect that continuation in the home would be contrary to the welfare of the child and that placement is in the best interest of the child.
(6) A copy of the signed JFS 01645 "Agreement for Temporary Custody of Child" along with a copy of a court determination that continuation in the home would be contrary to the welfare of the child and that the placement is in the best interest of the child.
(7) A copy of the court order committing the child to the permanent custody of an Ohio PCSA or Ohio private child placing agency (PCPA), or a copy of the JFS 01666 "Permanent Surrender of Child." In cases where the child initially entered permanent custody as the result of the execution of a JFS 01666, there is to be a copy of a court determination that continuation in the home would be contrary to the welfare of the child and that the placement is in the best interest of the child.
(8) A copy of the signed JFS 01654 "Adoptive Placement Agreement."
(9) Initial child study inventory.
(10) A copy of the JFS 01616 "Social and Medical History."
(11) A copy of the JFS 01673 "Assessment for Child Placement (Homestudy)" or another state's approved child with special needs homestudy.
(12) A copy of the JFS 01673A "Ohio Department of Job and Family Services Child Characteristics Checklist for Foster Care and/or Adoption."
(13) A copy of the JFS 01689 "Documentation of the Placement Decision-Making Process."
(14) A copy of the JFS 01692 "Application for Adoption of a Foster Child or Sibling Group."
(15) A copy of the JFS 01667 "Adoption Information Disclosure."
(16) A copy of the JFS 01699 "Prefinalization Adoption Assessment Report."
(17) If the basis for determination of AA eligibility is meeting supplemental security income (SSI) eligibility requirements, a copy of the SSI voucher or a copy of any other official documentation verifying SSI eligibility.
(18) If the basis for determination of AA eligibility is ADC-relatedness, copies of all documentation used for the determination.
(19) The eligibility determination for the child of a minor parent who is eligible for a Title IV-E foster care maintenance (FCM) payment.
(20) If the basis for determination for AA eligibility is that the child was placed in the custody of the PCSA as a result of a JFS 01645 or JFS 01666, then copies of all documentation used for determination.
(21) A copy of the ODM 06612 "Health Insurance Information Sheet" as completed by the adoptive parent(s).
(22) A copy of the adoption petition filed with the court.
(23) A copy of the adoption finalization.
(24) A copy of the signed JFS 01453 "Title IV-E Adoption Assistance Agreement" between the adoptive parents and the PCSA and any amendments.
(25) Documentation of current eligibility for AA, and in a prior finalized adoption.
(26) A copy of the documentation evidencing repayment of any identified AA overpayment.
(27) A copy of all state hearing, administrative appeal, and judicial review documentation.
(28) A copy of the JFS 01470 "Title IV-E Adoption Assistance State Mediation Conference Request."
(29) A copy of the interstate compact and adoption medical assistance forms.
(C) For applications received from an adoptive parent(s) who resides out of state, the case record is to include a copy of forms which contain, at a minimum, the information needed by the JFS 01673, JFS 01692 and child study inventory.
(D) In order to protect confidentiality of adoption records, the dates of the documents listed in paragraphs (B)(4) to (B)(7) of this rule may be included in the AA case record in place of copies of the court order, JFS 01645, JFS 01666, or petition for adoption. For auditing purposes these documents are to be provided upon request. Provision of these dates by the PCSA is to be recognized as evidence that copies of the legal records exist. The following information is to be provided on the children services agency (CSA), PCPA's or PCSA's letterhead.
(1) Each document is to be clearly identified.
(2) The effective date of each record.
(3) The PCSA representative's signature, confirming that the record is on file at the PCSA.
(E) When applicable, the PCSA is to contact the PCPA which placed the child for adoption in order to obtain verification of the date of the documents listed in paragraph (B) of this rule. Documentation of these dates by the PCPA are to be recognized as evidence that copies of the legal records exist. For auditing purposes these documents is to be provided upon request. The following information is to be provided on the PCPA's letterhead.
(1) Each record is to be clearly identified.
(2) The effective date of each record.
(3) The PCPA representative's signature confirming that the record is on file at the PCPA.
(4) Pre-adoptive identifying information which is needed to establish eligibility for AA.
(F) The PCSA and PCPA are to use the pre-adoptive identifying information when contacting the public assistance benefits eligibility or referral specialists to request pertinent information on file, or when contacting the social security administration to request pertinent information about the child's eligibility for SSI. The PCSA and PCPA are not to provide any information about the child's new identity or present situation.
(G) Pursuant to rule 5101:2-33-23 of the Administrative Code the adoption assistance case record is to be permanently retained.
Last updated October 15, 2024 at 11:17 AM
Supplemental Information