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NJ DCF Logo with reverse copy 

 

New Jersey Department of Children and Families Policy Manual

 

Manual:

CP&P

Child Protection & Permanency

Effective Date:

2-11-2019

Volume:

X

Forms

Chapter:

A

Forms

Revised

Date: 10-5-2020

Subchapter:

1

Forms

Issuance:

5.45

CP&P Form 5-45, Adolescent Program Referral Information Sheet

 

 

Click here to view CP&P Form 5-45, Adolescent Program Referral Information Sheet

 

NOTE: This is a NJ SPIRIT form. The version in the policy manual forms section is for illustration purposes only.

 

WHEN TO USE IT

 

CP&P Form 5-45 is used by DCF to submit independent living service referrals for youth between the ages of 14 – 21. This form captures information and special instructions used by adolescent service providers delivering independent living services (such as, but not limited to housing, life skills, and mentoring). Once delivered, all independent living services meeting the federal National Youth in Transition Database (NYTD) reporting guidelines shall report back to DCF by the adolescent service providers.

 

Use this form when:

  • The Caseworker identifies an adolescent service need for a youth.
  • The adolescent service provider requests a referral ID/PIN for a youth.
  • Changes to the youth’s preferred name, Caseworker, or instructions occur.

 

Note:  This form is completed for each adolescent program referral.

 

 HOW TO USE IT

 

The Caseworker begins the process by creating the Adolescent Program Referral using the NJ SPIRIT Adolescent Program Referral window (NJS Desktop>Create Case Work>Adolescents). CP&P Form 5-45 is generated from the options menu on the Adolescent Program Referral window.

All information on the non-editable Adolescent Program Referral Information Sheet (5-45) is pre-populated from the Adolescent Program Referral window.  

Include the Adolescent Program Referral Information Sheet (5-45) with the youth’s referral packet sent to the service provider.

 

Changes to the youth’s preferred name, Caseworker assignment, or instructions to provider (up to 1000 characters) are made on the Adolescent Program Referral window. The updated form is reprinted and resent to the adolescent service provider.

 

Note: The Adolescent Program Referral Information Sheet (5-45) is sent only to the selected service provider. This form is not used to authorize a service referral or replace existing referral requirements.  Only those programs included in the list of Adolescent Service Providers and Programs attached below require this referral process.

 

OTHER RELATED INFORMATION

 

ATT1Adolescent Service Providers and Programs

 

DISTRIBUTION:

 

Original          -           Case Record

 

Copy               -           Adolescent Service Provider