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NJ DCF Logo with reverse copy

 

New Jersey Department of Children and Families Policy Manual

 

Manual:

CP&P

Child Protection and Permanency

Effective Date:

Volume:

X

Forms

Chapter:

A

Forms

5-10-2010

Subchapter:

1

Forms

Issuance:

14.182

CP&P Form 14-182, Application for Subsidized Adoption Payments

 

Click here to view, complete, and print the CP&P Form 14-182, Application for Subsidized Adoption Payments.

 

WHEN TO USE IT

This form is completed by a prospective adoptive parent who is requesting an adoption subsidy for up to three children in his or her care with the assistance of the child's Worker.  The letter identifies:

·         The amount of subsidy requested;

·         The specific components requested;

·         The child's special needs;

·         Whether the family has health and dental insurance, and, if so, whether this insurance covers the child's special needs; and

·         Whether the child receives income from any other sources, and the monthly amounts of that outside income.

The Worker submits the original signed copy of the CP&P Form 14-182, Application for Subsidized Adoption Payments, on behalf of the applicant, as a component of the adoption subsidy packet, sent to the Office of Adoption Operations for approval. A complete, signed CP&P Form 14-182 is required with the subsidy request.

See CP&P Form 14-220, Request for Subsidy Approval Memo Checklist, for additional policy, procedures and documentation that must be submitted to the Office of Adoption Operations.

After the subsidy request is approved, file the original signed copy of CP&P Form 14-182 in the child's case record. After the adoption is finalized, file a copy of the form in the family's adoption subsidy folder.

Note: If applying for subsidy on behalf of four or more children, complete a second copy of the form for the additional children.

 

HOW TO USE IT

·         The Worker prepares portions of this letter using the on-line template in the computerized Forms Manual.  Enter the child's name and case ID number, the name of each adoptive parent, and the name and address of the Local Office.  Include the current board rate paid to the resource home.

·         Complete the remainder of the form with the prospective adoptive parent(s).

·         Send the signed form to the Assistant Director of Adoption Operations in the subsidy request packet.

SPECIAL NOTE

CP&P Form 14-182 must be signed by the adoptive parent. Do not confuse it with the CP&P Form 14-184, Agreement Between the New Jersey Division of Child Protection and Permanency and Adoption Parents Regarding Subsidy Payments, which must be sent to the Office of Adoption Operations for approval without the signature of the adoptive parent.

 

TIPS FOR COMPLETING THE FORM

·         Complete all appropriate text fields in the template. Print the form to complete the remainder of the form with the prospective adoptive parent.

·         In the appropriate space, enter an explanation of the child's special needs.

·         Questions regarding the family's health and dental insurance must be completed.

DISTRIBUTION

 

Original

-

Office of Adoption Operations for approval

 

-

After approval, file in the child's case record

Copy

-

After Office of Adoption Operations approval is received, give a copy to the adoptive parent with a copy of CP&P Form 14-184 attached

 

 

After the adoption is finalized, file in the family's adoption subsidy folder