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New Jersey Department of Children and Families Policy Manual

 

Manual:

CP&P

Child Protection and Permanency

Effective Date: 5-14-2012

Volume:

X

Forms

Chapter:

A

Forms

Revised Date: 2-4-2019

Subchapter:

1

Forms

Issuance:

14.184

CP&P Form 14-184, Agreement Between the New Jersey Division of Child Protection and Permanency and Adoptive Parents Regarding Subsidy Payments

 

Double click here to view, print, or complete the CP&P Form 14-184, Agreement Between the New Jersey Division of Child Protection and Permanency and Adoptive Parents Regarding Subsidy Payments.

 

Click here to view or print this form in Spanish, CP&P Form 14-184(s)

 

WHEN TO USE IT

Use this form:

·         To document the terms and conditions of the adoption subsidy which takes effect:

 

-       At the time of the child's placement in a select home adoption;

-       The date of adoption finalization for a foster home adoption;

-       On the date that the application for subsidy was received by CP&P from a private agency or the date of placement, whichever is later, for an adoption through a private agency (N.J.A.C. 10:121-1.3(e)); or

-       Retroactive to the date of the request for reconsideration of subsidy eligibility for a child who was not subsidy eligible at the time of adoption finalization, but is now determined to be eligible, unless the family caused an undue delay (e.g., three (3) months or longer).

·         When a change in the terms of the subsidy (e.g., increase in subsidy rate or for special services) is approved by the Assistant Director of the Office of Adoption Operations or his or her designee.  The revised agreement takes effect retroactive to the date of the request for a change, unless the family caused an undue delay (e.g., three (3) months or longer).

HOW TO USE IT

After determining that the child is eligible for subsidy, the Worker engages the prospective adoptive parents in a discussion of the terms and conditions of the adoption subsidy program including, but not limited to:

·         The child's special needs and the individualized plan to meet these needs;

·         The proposed subsidy rate;

·         The child's eligibility for any special services;

·         Non-recurring expenses and the procedures for reimbursement;

·         Eligibility for Post Adoption Child Care (PACC), if the child is under the age of six;

·         Other benefits and exemptions available to the child or adoptive family through New Jersey and Federal entitlement programs (e.g., Supplemental Security Income (SSI), Old Age, Survivors, and Disability Insurance (OASDI)) and Federal income tax provisions, including the Federal tax credit);  and

·         The annual notice they will receive from CP&P regarding their legal responsibilities for their child's adoption subsidy and their obligation to notify the Office of Adoption Operations immediately if any of the child's or family's eligibility requirements/circumstances change.

After the discussion, complete and submit the CP&P Form 14-184 to the Office of Adoption Operations for approval and signature by the Assistant Director of the Office of Adoption Operations or his or her designee.  Note: The prospective adoptive parents sign the agreement after it is approved by the Office of Adoption Operations.

Submit the form as part of the subsidy request packet.  See CP&P Form 14-220, Request for Adoption Subsidy Approval Memo Checklist, in the on-line Forms Manual (11-20) for policy, procedures, and documentation required for the adoption subsidy request packet.

After the subsidy request is approved by the Office of Adoption Operations, the Worker reviews the terms and conditions of the approved agreement with the prospective adoptive parents during the Pre-Consent Interview. 

Have the prospective adoptive parents sign the CP&P Form 14-184, and one copy, if they are in agreement with its terms and conditions.  After the prospective adoptive parents sign, they return the original to the Local Office Worker and retain the copy for their records.  File the original, approved, and signed form in the child's case record.

Note:  Unless the child is not subsidy eligible, the CP&P Form 14-184 must be signed by all parties (i.e., the Office of Adoption Operations and then the prospective adoptive parents) before the Local Office Manager signs the CP&P Form 14-6, Consent of Guardian to Adoption, or the CP&P Form 14-149, Consent of Custodian to Adoption, and the adoption is finalized.

 

TIPS FOR COMPLETING THE FORM

·         On the top left of the form indicate whether the Agreement is an initial or revised Agreement. This information is important for Title IV-E claiming.

·         Complete all applicable check boxes and text fields.

·         The specific categories of children eligible for subsidy may change over time.  Consult the CP&P Form 14-219, Basis for Subsidy Eligibility, for the current eligibility criteria.  Check all criteria used to determine eligibility for the adoption subsidy.

·         Under non-recurring expenses, enter the current rate approved for legal fees that will be paid to the family's attorney.

·         Regarding post-adoption services, check the appropriate box after discussing these services with the prospective adoptive parents.

·         Submit all required documentation to the Office of Adoption Operations.

Note: At the 12th check box, high risk related to prenatal drug exposure, "exposure to marijuana" only would not make the child subsidy eligible.

 

DISTRIBUTION

 

Original

-

After approved and signed by Office of Adoption Operations and then prospective adoptive parents, file in child's case record 

Signed Copy

-

Retained by prospective adoptive parents (with copies of CP&P Forms 14-182 and 14-183)