Illinois Department of Children & Family Services
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Child Abuse Hotline
800-25-ABUSE
(800-252-2873)

217-785-4020
(for international calls only)

DCFS Info and Assistance
(Advocacy Office)
800-232-3798
217-524-2029

Day Care Information
877-746-0829
312-328-2779

Foster Parent Hotline
800-624-KIDS
(800-624-5437)

Adoption Information
800-572-2390

Youth Hotline
800-232-3798

Missing Child Helpline
866-503-0184
Illinois Home

Inspector General

Agencies, Boards & Commissions

Inspector General
800-722-9124

Chicago Administrative Headquarters
100 West Randolph Street 6-200
Chicago IL 60601
312.814.6800
TTD 312.814.8783

Springfield Administrative Headquarters
406 East Monroe
Springfield IL 62701-1498
217.785.2509
TTD 217.785.6605

Media Inquiries/ Communications Office
312-814-6847

Illinois Putative Father Registry

National Center for Missing and Exploited Children

Illinois Amber Alert

Illinois Employer Report Form

  Forms  

 Formas en Español

 

This page includes all DCFS forms available online. Forms are available for view in either or both of the following formats:
  • Adobe Acrobat (pdf)
  • MS Word for Windows (doc)
Cost and Budget Reporting

 

  CANTS Forms  

CANTS 4 Written Confirmation of Suspected Child Abuse/Neglect Report: Medical Professionals
CANTS 5 Written Confirmation of Suspected Child Abuse/Neglect Report: Mandated Reporters
CANTS 8 Notification of a Report of Suspected Child Abuse and/ or Neglect
CANTS 8-Polish ZGŁOSZENIE DONIESIENIA O PODEJRZENIU O ZNĘCANIU SIĘ / ZANIEDBYWANIU DZIECI
CANTS 9 Notification of Intent to Indicate Child Care Worker for Report of Child Abuse and/or Neglect
CANTS 10 Notification of Intent to Indicate Child Care Worker for Report of Child Abuse and/or Neglect Questions and Answers
CANTS 11 Notification of Decision in an Employment Related Report of Child Abuse and/or Neglect
CANTS 22 Acknowledgment of Mandated Reporter Status Form
CANTS 22-A Acknowledgment of Mandated Reporter Status (Clergy) Form
CANTS 22-B Acknowledgement of Mandated Reporter Status
CANTS 48 Request for LEADS/CANTS Check
CANTS 65-A Referral Form for Medical Evaluation of a Physical Injury to a Child

 

  FFH Packet  

Application Packet Initial Foster Family Home License: Related Caregivers (11/09)

 

  CFS Forms  

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 Issues
CFS 231 ACR Critical 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 307-1 Indian Child Welfare Advocacy Program Referral Form (Fillable)
CFS 307-2 Indian Child Welfare Advocacy Program Intake Form (Fillable)
CFS 356 ACR Satisfaction Survey (fillable)
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 Psychology Department Testing Referral Form
CFS 417-B Psychological or Neuropsychological Testing/Parenting Capacity Assessment Feedback Reimbursement Form
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 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 583-A Certification of Inspection for Unsafe Childrens Products (Facilities)
CFS 583-B Certification of Inspection for Unsafe Childrens Products (Homes)
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 585-2 Certification of Radon Test
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 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 Clinical Intervention For Placement Preservation (CIPP) Meeting Referral Form
CFS 1452-2 Clinical Intervention For Placement Preservation (CIPP) Action Plan
CFS 1452-3 Referral Packet Documentation Checklist
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 ]
 

  Voter Registration Forms (In accordance with (10 ILCS 5/1A 17))  

OR-19 Voter Registration Form
Visit the Illinois State Board of Elections web site for more details

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