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New Jersey Department of Children and Families Policy Manual

 

Manual:

CP&P

Child Protection and Permanency

Effective Date:

Volume:

X

Forms

Chapter:

A

Forms

6-30-2003

Subchapter:

1

Forms

Issuance:

4.16

CP&P Form 4-16, Certification of Caregiver of Minor as to Knowledge or Location of Parents for Kinship Legal Guardianship

 

 

Click here to view or print the CP&P Form 4-16, Certification of Caregiver of Minor as to Knowledge or Location of Parents for Kinship Legal Guardianship.

Instructions 6-30-2003

PURPOSE AND USE

This form is used by the Division of Child Protection and Permanency (CP&P) under the Kinship Legal Guardianship Subsidy Program and the Division of Family Development (DFD) under the Kinship Navigator Program.

The purpose of the form is for the relative or family friend caregiver to certify to the court specific information concerning his or her knowledge and the whereabouts of the parents of a child participating in the Kinship Legal Guardianship Subsidy Program.

Instructions for Completing the Form

The Worker/Relative Care Specialist provides the CP&P Form 4-16 to the caregiver to complete.  The caregiver completes the CP&P Form 4-16 as follows:

1.    Enter the name of the minor (child) in the upper, middle potion of the form.

2.    Enter your name (caregiver) in the opening portion of the form.

3.    Enter your (caregiver) relationship to the minor (child) under item number 1.  Enter "family friend" if there is no legal relationship to the child.

4.    Enter the minor's (child's) name and the address where you (caregiver) and the minor (child) reside under item number 2.

5.    Enter the minor's (child's) name, present age, gender, date of birth and his or her birth address or location under item number 3.

6.    Enter the name of the minor's (child's) mother; the date of your (caregiver) last contact with the mother; and the last known address of the mother under item number 4.

7.    Enter the name of the minor's (child's) father; the date of your (caregiver) last contact with the father; and the last known address of the father under item number 5.

8.    Check all the statements that apply under item number 6.

9.    Sign and date the form.

10. Return the completed form to the Worker/Relative Care Specialist.

The Worker/Relative Care Specialist submits the completed CP&P Form 4-16 to the court along with the CP&P Form 4-5, Kinship Legal Guardianship Assessment, and CP&P Form 4-5a, Certification of Completed Background Checks for Kinship Legal Guardianship.

DISTRIBUTION

Original          -           Appropriate County Superior Court of New Jersey Chancery Division – Family
Part

Copy               -           Case record (child)

Copy               -           Case record (caregiver)