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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:

14.233

CP&P Form 14-233, Post Adoption Child Care Referral Form (Non-continuation of Service)

 

Click here to view and print the CP&P Form 14-233, Post Adoption Child Care Referral Form (Non-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 not currently receiving voucher child care was recently adopted and is eligible to apply for post adoption voucher child care services;

 

•           Provide identifying information on the child, including the child's birth and adopted names, his or her birth date, 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 14-233 using the on-line template in the computerized Forms Manual.

 

•           Within one week following the adoption finalization, send the form to the appropriate 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 CP&P 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 Adoption Subsidies, 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