Click here to view and print the CP&P Form 14-232, Post Adoption Child Care Referral Form (Continuation of Service).

WHEN TO USE IT

Use this form to:

•           Notify the county Child Care Resource and Referral (CCR&R) agency  that a child who is currently receiving voucher child care was recently adopted and is eligible to apply for post adoption voucher child care services;

•           Provide the child's identifying information, including the child's birth and adopted names, his or her birthdate, Social Security number, CP&P case number, and CP&P Adoption Subsidy Case number; and

•           Confirm that the adoptive parent was informed that the application must be returned to the CCR&R agency within 90 days of the adoption finalization or eligibility will be forfeited.

HOW TO USE IT

•           Prepare the CP&P Form 14-232 using the on-line template in the computerized Forms Manual.

•           Within one week following the adoption finalization, send the form to the county CCR&R agency.

•           Send a copy of the form to the adoptive parent with the CP&P Form 14-230, Post Adoption Child Care Referral Letter to Adoptive Parent, and form 14-231, Adoption Subsidy Addendum Agreement for Post Adoption Child Care, and the DFD application forms for the PACC program. 

TIPS FOR COMPLETING THE FORM

See CP&P-IV-C-8-900, Post Adoption Child Care (PACC), and CP&P-IV-C-8-200, Processing the Adoption Subsidy, and its subsections for more details regarding the discussion of the PACC program with prospective adoptive parents.

Note:  The CP&P Adoption Worker was required to give to each parent (resource or select home) adopting a child under the age of six the DCF pamphlet entitled "Post Adoption Child Care (PACC): A Guide for Adoptive Parents." The adoptive parent must sign an acknowledgment receipt that he or she received the pamphlet.  Include the signed verification of the parent's receipt of the PACC pamphlet with the CP&P Form 14-219, Basis for Subsidy Eligibility, and send to the Office of Adoption Operations in the subsidy request package.

DISTRIBUTION

Original          -           CCR&R agency

Copy               -           Adoptive parent(s)

-           Family's Adoption Subsidy Folder

                        -           Local Office Child Care Liaison