|
| CFS 119 Unusual Incident Reporting Form |
| CFS 119-A Unusual Incident Disposition Form |
| CFS 119-W UIR Waiver Request |
| CFS 123 Electronic Mail Communication and Distribution Certificate of Understanding |
| CFS 151 Notice of Decision |
| CFS 151-A Notice of Decision to Remove Unrelated Children |
| CFS 151-B, Notice of Change of Placement Form |
| CFS 151-C, Placement Review Summary Form |
| CFS 151-D, Placement Review: Action Plan |
| CFS 151-E Summary of Clinical Placement Review |
| CFS 151-F Summary for Placement Review |
| CFS 151-G Notice of Critical Decision |
| CFS 152 Disability Related Services Report |
| CFS 152A Children's Account Unit Assessment Form |
| CFS 152B Children's Account Unit Disbursement Request Form |
| CFS 230 ACR Feedback Response and Action Plan (FRAP)for Critical or Chronic Issues |
| CFS 231 ACR Feedback Communication Notice |
| CFS 250 Guiding the Caregiver Through Self-Assessment for Reunification Support |
| CFS 250-A Discussion Questions to Consider with Caregivers Before Self-Assessment |
| CFS 301-80 Waiver of Criminal Record of a Relative |
| CFS 356 ACR Satisfaction Survey (fillable).pdf |
| CFS_370-1 Norman Class Certification For Reunification or Intact Family Cases |
| CFS_370-4 Notice to Norman Class Members |
| CFS_370-5 Request for Cash Assistance and/or Housing Advocacy Type of Service Requested |
| CFS_370-5C Monthly Budget Form |
| CFS_370-5Y Monthly Budget Form for Youth |
| CFS_375-1 ILO TLP Request for Extention of Services (Fillable) |
| CFS_375-1 ILO TLP Request for Extention of Services (With lines to complete by hand) |
| CFS_375-4 Notice to Norman Class Members |
| CFS_375-2 ILO TLP Quarterly Transition Discharge Launch Plan (password protected Word document) |
| CFS 387 Adoption and Safe Families Act (ASFA) Survey for ACR - Fillable.pdf |
| CFS 399-1 Clinical Referral Form (Rev 4-2010) |
| CFS 399-2 Help Unit Face Sheet |
| CFS 399-6 Specialty Services Case Consultation Referral Form |
| CFS 402-1 Waiver Of Licensing Standards For Foster Family Homes - Instructions |
| CFS 402-1 Waiver Of Licensing Standards For Foster Family Homes |
| CFS 403 Final And Irrevocable Consent To Adoption By A Specified Person Or Persons |
| CFS 403-B Affidavit of Identification |
| CFS 403-C Birth Parents' Rights and Responsibilities |
| CFS 403-C-Polish PRAWA I OBOWIĄZKI RODZICÓW BIOLOGICZNYCH W STANIE ILLINOIS |
| CFS 403-D Adoptive Parents' Rights and Responsibilities |
| CFS 403-D-Polish PRAWA I OBOWIĄZKI RODZICÓW ADOPCYJNYCH W STANIE ILLINOIS |
| CFS 407-3 Community College Payment Program (Fillable) |
| CFS 407-4 Education Profile (Assessment) |
| CFS 411 Investigatory Report |
| CFS 414 Letter to the Judge-Costs Incurred during a Child Custody Investigation (Fillable) |
| CFS 417 Referral Form for Psychological Evaluation |
| CFS 418 Levels of Care Assessment Form |
| CFS 418-J Checklist for Children at Initial Placement |
| CFS 426 Adoption Placement Agreement |
| CFS 426-4 Legal Risk Placement Agreement |
| CFS 427 AFFIDAVIT OF AGENCY |
| CFS 428 Application/Record of Child Information |
| CFS 431-1 Consent of Guardian to Mental Health Treatment (Fillable) |
| CFS 431-2 Outpatient Psychiatry Request Form |
| CFS 431-A Psychotropic Medication Request |
| CFS 431-A Psychotropic Medication Request Fax Cover Sheet |
| CFS 431-D Request for Copy of Psychotropic Medication (or Other*) Consent |
| CFS 433-1 Waiver of Religious Faith and Preference in Adoptive Placement |
| CFS 435 Final and Irrevocable Surrender to an Agency for Purposes of Adoption of a Born Child |
| CFS 435-2 Surrender To An Agency For Purposes Of Adoption Of An Unborn Child(ren) |
| CFS 437-3A Denial of Paternity with Entry pf Appearance and Consent to Adoption |
| CFS 438 Scholarship Program Student Application |
| CFS 440-4 Guide to Risk Factors for Substance Affected Families & Substance Exposed Infants |
| CFS 440-5 Adult Substance Abuse Screen |
| CFS 440-6 Referral for Adult Alcohol and Other Drug Treatment Services |
CFS 440-7 Consent for Disclosure of Information; Substance Abuse Assessment and/or Treatment
|
| CFS 440-8 Youth Alcohol and Other Drug Abuse Indicators |
| CFS 440-9 Recovery Matrix - Placement Cases |
| CFS 440-10 Recovery Matrix - Intact Cases |
| CFS 440-11 Substance Affected Families Procedures Checklist |
| CFS 440-12 Investigation/Intact Parental Mental Health Case Matrix |
| CFS 444-2 Appointment_of_Short-Term_Guardian |
| CFS 448 Adoption Listing Service Family Registration Agreement |
| CFS 449 Youth in College/Vocational Training Application |
| CFS 449-1 GPA Education Plan |
| CFS 449-2 Employment Incentive Program Application |
| CFS 449-3 Application for Education and Training Voucher Funds |
| CFS 452 Well Water Agreement |
| CFS 452-1 Water Temperature Agreement |
| CFS 452-2 Foster Family Firearms Agreement |
| CFS 452-3 Acknowledgement of Understanding Concerning Prohibition of Corporal Punishment |
| CFS 452-4 Business or Employment Related Child Supervision Plan |
| CFS 452-5 Safety Plan for Pools, Hot Tubs, Ponds, and Other Potential Water Hazards |
| CFS 452-6 Request for Access to Social Security Number Foster Child(ren) |
| CFS 452-A Acknowledgement of Compliance Part 402 Licensing Standards for Foster Family Homes |
| CFS 452-B Non-Active Status Request |
| CFS 452-C Re-Activation Status Agreement/Removal of Non-Active Status |
| CFS 453-A Placement Alternative Contract Safety Checklist |
| CFS 453-B Placement Alternative Contract Additional Safety Checklist for a Parenting Youth Whose Children Will Share or Visit the Placement |
| CFS 453-C Placement Alternative Contract 90 Days Self-Sufficiency Plan [ doc ] |
| CFS 454 HMR Placement Safety Checklist |
| CFS 454-A Relative Caretaker Information |
| CFS 457 Confirmation of Family Meeting |
| CFS 458 Relative Caregiver Placement Agreement |
| CFS 458-A Affidavit of Relationship |
| CFS 462-1 Cook County Temporary Custody Hearing Results Form |
| CFS 467 Statement of Intent |
| CFS 468-1 Adoption Listing Service (ALS) Child Registration Form |
| CFS 468-1a Adoption Listing Service Listing Eligibility Form |
| CFS 470-H Affidavit of Information Disclosure for Adoption |
| CFS_482-B Special Needs_Certification (Fillable) .pdf |
| CFS 483 Caseworker Permanency Planning Checklist |
| CFS 483-1 Caregiver Permanency Planning Checklist |
| CFS 485 Individualized Assessment of Child for Purposes of Adoption Form |
| CFS 486 Adoption Conversion Assessment |
| CFS 486-G Subsidized Guardianship Conversion Assessment |
| CFS 490 Interstate Compact Placement Request |
| CFS 490-1 Interstate Compact Report on Child's Placement Status |
| CFS 490-1A Interstate Adoption Agency Placement Information |
| CFS 490-13 Interstate Home Study Outline |
| CFS 492-L Contact License Entry Note[doc ] |
| CFS 496 Client Rights and Responsibilities |
| CFS 506-A Foster Home Change Of Address Licensing Assessment |
| CFS 506-F Foster Home Information |
| CFS 506-I Initial Foster Home Licensing Assessment |
| CFS 506-R Foster Home Renewal Licensing Assessment |
| CFS 507 Resource Referral Form |
| CFS 508 Report of Persons Employed in a Child Care Facility |
| CFS 508-1 Information on Person Employed in a Child Care Facility |
| CFS 531 DCFS Regional Nurse Referral Form |
| CFS 534 Medication Administration Log |
| CFS 534-1 Behavior Log |
| CFS 542 Initial Inquiry |
| CFS 560 Child Support Certification |
| CFS 574 Foster Parent Training Credit Approval Form |
| CFS_574-2 Agency Reporting Form For Adoptive Parent Training Curriculum (includes all 3 Curriculum Content Checklists) |
| CFS 578-1 Confirmation of Interest in Foster Home Licensure |
| CFS 578-2 New Relative Placement Practice Guide |
| CFS 578-3 Payment Comparison Worksheet |
| CFS 578-4 Request to Transfer Licensing Responsibility for HMR Home [doc ] |
| CFS 578-5 Comparison: Standard of Need vs. Foster Care Board Rate |
| CFS 578-6 Rational For Not Submitting a License Renewal Application [doc ] |
| CFS 578-7 Reason For Expired Renewal Application [ doc ] |
| CFS 583-A Certification of Inspection for Unsafe Children's Products for Facilities |
| CFS 583-B Certification of Inspection for Unsafe Children's Products for Homes |
| CFS 585 Documentation Of Inspection Of Smoke Detector In Foster Or Relative Caregiver Home |
| CFS 585-1 Fire Evacuation Plan |
| CFS 593 Consents to Day Care Providers |
| CFS 594A Certification of Re-Examination of Licensed Foster Home Following “Indicated” Child Abuse/Neglect Finding |
| CFS 596-G-W Protective Plan Forwards With Criminal Histories And Indicated Abuse/Neglect Reports |
| CFS 596-P Licensed Child Welfare Agency Management Self-Report |
| CFS 596-Q Annual Report for Illinois Licensed Adoption Agencies |
| CFS 596-R Accounting of Adoption Agency Payments Of Salaries and Other Compensation |
| CFS 597-E Request For Assignment of License Personnel ID |
| CFS 597-R Application for Foster Family Home License for Relative Caregivers |
| CFS 600 Certificate of Child Health Examination |
| CFS 600-3 Consent for Release of Information |
| CFS 600-4 Sharing Information with the Caregiver |
| CFS 601 Dental Examination Form |
| CFS 602 Medical Report on an Adult in a Child Care Facility |
| CFS 604 Medical Evaluation of an Adult in a Foster or Adoptive Home |
| CFS 604-1 Foster Home Utilization Assessment |
| CFS 613 Family Assessment Consent_Form |
| CFS 613-1 Family Assessment |
| CFS 613-2 Voluntary Family Enhancement Plan |
| CFS 613-3 DR Request for Cash Assistance |
| CFS 613-4 DR Cash Assistance Reconciliation Advance Request |
| CFS 613-5 DR Final Cash Assistance_Reconciliation |
CFS 670 Landlord Approval To Operate Licensed Day Care Business
|
| CFS 671 Child Care Facility Driver Application |
| CFS 680 Child Identification Form |
| CFS 680-A Missing Child De-briefing Form |
| CFS 685 Ward's Supervision Plan |
| CFS 685-1 Adjudicated Sex Offender / Adult Registry Staffing Checklist |
| CFS 687 Sexual Abuse Program Summary of Review and Screening |
| CFS 688 Foster Home Motor Vehicle Insurance Certification |
| CFS 689 Authorization For Background Check For Programs Not Licensed By DCFS |
| CFS 690 Asthma Action Plan |
| CFS 691 Identification of a Child Diagnosed With Asthma |
| CFS 717-E Authorization For Background Checks For Direct Child Welfare Services Employee Licensure Board |
| CFS 717-F Authorization For Background Checks For Child Welfare Services Employee Licensure Board |
| CFS 717-G Direct Service Child Welfare Employee License Application |
| CFS 718 Authorization For Background Check (fillable) |
| CFS 718-3 Background Check Roster/Registro de Verificación de Antecedentes |
| CFS 718-E Authorization For Background Check For Employees/Volunteers of Child Care Facilities |
| CFS 718-L Request for Updated background Check for a Licensed Provider |
| CFS 718-RL Background Check for Relatives Applying for Foster Home License |
| CFS 718-W Authorization For Background Check Of Wards Of The State |
| CFS 718-4 Request For Transfer of Background Clearance Information |
| CFS 731 Certification of Driver's License and Automotive Coverage (Fillable) |
| CFS 744 ADA Grievance Form (Fillable) |
| CFS 834-A Records Recall Request-Closed Records other than Child Welfare and Adoption Files (Fillable) |
| CFS 834-B Records Recall Request-Closed Records Child Welfare and Adoption Files (Fillable) |
| CFS 851 Foster Parent Reimbursement Program Claim Form |
| CFS 855 Foster Parent/Relative Caregiver Notice of Disclosure of Identifying Information |
| CFS 888-3 Case Action Form |
| CFS 899-A Two Letter State Abbreviations |
| CFS 906-4 Special Service Fee and Payment Extension Form |
| CFS 906-E Placement-Payment Authorization_Form (Department_Foster_Care) (With_Email_Submit_Buttons).pdf |
| CFS 906-1-E Placement-Payment Authorization Form (Private_Agency, Institution, Group Home) (With Email Submit Buttons).pdf |
| CFS 906-5 Residential Care Bed Hold Payment Request |
| CFS 912 Life Skills Referral Form |
| CFS 920 Statement of_Money Paid by County |
| CFS 921 Statement of_Certification |
| CFS 922 Statement of_Money Received County |
| CFS 968-62 Lan Program Tools |
| CFS 968-62A Child and Family Team Member Signature Sheet |
| CFS 968-62B ILO/TLP Safety and Risk Management Plan |
| CFS 968-62C ILO/TLP Wraparound Plan |
| CFS 968-62D ILO/TLP Staffing Summary |
| CFS 968-62E Caseworker Preparation Checklist for ILO/TLP Staffing |
| CFS 968-62F ILO/TLP Provider Matching Acceptance Form |
| CFS 968-75 Provider Matching Acceptance Form for Reach In |
| CFS 968-90 Questions for Mental Health Professionals (Fillable) |
| CFS 969-1 Understanding of Future Eligibility for the Enhanced Subsidized Guardianship and Adoption Services Program |
| CFS 969-2 Application for Transitional Services Available in the Enhanced Subsidized Guardianship/Adoption Program[doc ] |
| CFS 1000-1 Hispanic Client Language Determination Form |
| CFS 1000-A Burgos Notification Form [ doc ] |
| CFS 1000-6 Notification to Mexican Consulate |
| CFS 1016 Special Immigrant Juvenile Referral Form |
| CFS 1042-L Family Reunification Support Special Service Fee Log |
| CFS 1050-21 Mandated Reporter Manual |
| CFS 1050-45 Post Adoption Guardian Services Manual |
| CFS 1420 SACWIS Permanency Goal Form |
| CFS 1425 Change of Status Form |
| CFS 1426 POS Approval for Case Transfer [ doc ] |
| CFS 1427 IDCFS Statewide Legal Screening Form |
| CFS 1427-A Statewide Legal Screening Packet For Termination of Parental Rights/Adoption, Guardianship and Expedited Adoption |
| CFS 1441 CERAP Safety Determination Form |
| CFS 1441-A, Safety Plan Form |
| CFS 1441-B Safety Plan Termination Agreement |
| CFS 1441-C Safety Plan Team Assessment Meeting Form [ doc ] |
| CFS 1443 Permancy Commitment By Foster Parent / Relative Caregiver |
| CFS 1452-1 CAYIT Universal Referral Form |
| CFS 1455 Residential Transition 30 Day Post Discharge CAYIT Referral[ doc ] |
| CFS 1800-A-1 Adoption Assistance Eligibility for Children Not Under the Legal Responsibility of Illinois Department of Children and Family Services |
| CFS 1800-A-A Adoption Assistance Eligibility Determination |
| CFS 1800-A-G Subsidized Guardianship Eligibility Determination |
| CFS 1800-B-A Adoption Assistance Application |
| CFS 1800-B-G Subsidized Guardianship Application |
| CFS 1800-C-A Interim Adoption Assistance Agreement |
| CFS 1800-C-A Adoption Assistance Agreement |
| CFS 1800-C-G Subsidized Guardianship Agreement |
| CFS 1800-C-G Interim Subsidized Guardianship Agreement |
| CFS 1800-D Direct Payment to Attorney |
| CFS 1800-E Welcome Letter |
| CFS 1800-F Amendment to Agreement for Assistance |
| CFS 1800-H Termination of Adoption/Guardianship Assistance |
| CFS 1800-I Follow-up Letter to telephone call re change in childs needs |
| CFS 1800-J Letter acknowledging receipt of written request |
CFS 1800-K Post Adoption/Guardianship Services Review Committee
Request for Additional Services |
| CFS 1800-L Decision Letter Re Change in Child's Needs Circumstance |
| CFS 1800-M Notice of Intent to Discontinue Subsidy Payments on 18TH Birthday |
| CFS 1800-M-1 Notice of Intent to Discontinue Subsidy Payments on 18th Birthday (Fillable) |
| CFS 1800-M-1a Notice for Documentation to Continue Subsidy Payments Until Age 19 or 21 (Fillable) |
| CFS_1800-M-2 Final Notice of Intent to Discontinue Subsidy Payments (Fillable).pdf |
| CFS 1800-N Dissolved Subsidized Adoption/Guardianship Checklist |
| CFS 1800-O Termination of Iterim Adoption and Guardianship Assistance |
CFS 1800-P Adoption/Guardianship Verification of Ongoing Monthly Subsidy Payment Amount
|
| CFS 1800-Q Adoption Assistance/Subsidized Guardianship Medicaid Information Form |
| CFS 1800-R Status of continued Medicaid eligibility |
| CFS 1800-S Approved Subsidy Maintenance Form |
| CFS 1800-T-A Adoption Assistance Case Record Checklist |
| CFS 1800-T-G Subsidized Guardianship (KINGAP) Case Record Checklist |
| CFS 1800-U-60+ Subsidy Checklist |
| CFS 1900 ERC Intake and Referral Form-Disruption[ doc ] |
| CFS 1901 ERC Intake and Referral Form-DCP-Dependency[ doc ] |
| CFS_2000_Part_I_Day_Care_Services_Application_(Fillable).pdf |
| CFS_2000_Part_II_Day_Care_Rate_Certification_and_Agreement_(Fillable).pdf |
| CFS_2000_Part_III_Child_Abuse_&_Neglect_Tracking_System_Clearence_(Fillable).pdf |
| CFS 2016 Child Clinical Summary |
| CFS 2017 Child/Caregiver Matching Tool |
| CFS 2018 Inter-Ethnic Placement Act Assessment Form [ doc ] |
| CFS 2023 Special Needs Allowance Utilization Form [ doc ] |
| CFS 2025 Home Safety Checklist for Intact and Permanency Workers |
| CFS 2026 Home Safety Checklist for Parents, Caregivers, Family and Friends |
| CFS 2027 Home Safety Checklist for Child Protective Services Workers |
| CFS 2032-1 Youth Driven Transition Plan |
| CFS 2032 2 Your Future, Your Health - Power of Attorney for Health Care |
| CFS 2032-3 Certification of Receipt of Information & Education Regarding Health Care Options |
| CFS_2032-4 Supporting Emancipated Youth Services Intake Form (Fillable) |
| CFS_2032-4 Supporting Emancipated Youth Services Intake Form (With_lines_to_complete_by_hand) |
| Office of Inspector General Request for Information form. [ doc ] |
| |
