Instructions for Completing the Title IV-E Foster Care Eligibility Checklist

Instructions for Completing the Title IV-E Foster Care Eligibility Checklist

["X" prefix indicates that information obtained for this field is confidential and will not be disclosed for any purposes outside the review.]

SAMPLE REVIEW PERIOD. Record the beginning and ending date of the six-month sample review period. This six-month time frame corresponds to the AFCARS reporting period from which the sample was drawn.

STATE ABBREVIATION AND RANDOM SAMPLE SELECTION NUMBER. Record the two letter State abbreviation and the sample selection number assigned to this case.
CASE ID. Record the case number that is used as the identifier by the State.
COUNTY OR LOCAL OFFICE. Record the name of the county, if applicable.
DATE OF REVIEW. Record the date on which the case is being reviewed.
REVIEWED BY. Record the name of the individual reviewing the case. Please print.

A. CHILD INFORMATION

X1. CHILD'S NAME. Record the first and last name of the child whose case is being reviewed.
CHILD'S DATE OF BIRTH. Enter the month, day and year of the birth of the child whose case is under review.
CHILD'S AGE AS OF FIRST DAY OF SAMPLE REVIEW PERIOD. Enter the age of the child on the first day of the sample review period. If child is born during sample period, enter a zero. This is not mandatory but is used to determine the appropriate foster care maintenance payment consistent with the State's rate payment schedule.
IF THIS CHILD WAS 18 DURING THE SAMPLE REVIEW PERIOD, WAS (S)HE A FULL TIME STUDENT IN SECONDARY SCHOOL OR ITS EQUIVALENT AND EXPECTING TO GRADUATE PRIOR TO THE 19TH BIRTHDAY. When a child reaches the 18th birthday, eligibility for AFDC ceases unless, at State option, s/he is a full-time student in a secondary school or its equivalent and is expected to complete the program before age 19. If the State does not exercise this option, eligibility for title IV-E foster care ceases at the end of the month the child turns 18. If the State does exercise this option, eligibility for title IV-E foster care ceases at the end of the month the child leaves school or on the day of the 19th birthday--whichever comes first. Check N/A if the child is under 18 years of age. If the child is over the age of 18 and the State does not exercise this option, enter NO. The case is ineligible.

B. RELEVANT DATES. Note that the relevant dates for this section may precede the sample review period.
DATE CHILD WAS REMOVED FROM HOME. Record the date of the child's most recent removal from the home of the parent or specified relative pursuant to a court order or a voluntary placement agreement. This date is related to a child's initial eligibility for title IV-E and is tied to the judicial determinations of contrary to the welfare (or best interests) of the child and reasonable efforts to prevent removal.
DATE COURT ORDER REMOVING CHILD FROM HOME WAS INITIATED. Record the date of the filing of the petition that supports the child's removal from home. This date establishes the month in which AFDC eligibility is determined. A response of N/A indicates the child was not removed pursuant to a court order.

C. REMOVAL PURSUANT TO A COURT ORDER
WAS CHILD'S REMOVAL THE RESULT OF A JUDICIAL DETERMINATION. Removal of the child from home must be pursuant to a judicial determination or a voluntary placement agreement. The judicial determination must be made in a court order signed by a judge. If child was not removed pursuant to a court order, enter "NO" and proceed to #14.
DATE OF COURT ORDER REMOVING CHILD FROM HOME. Record the date of the court order that removes the child from home. The date of the court order is required, since FFP cannot begin until the first day of the month in which all eligibility requirements have been satisfied, including a judicial determination that remaining at home is contrary to the welfare of the child. The date of the court order removing the child from home is typically after the date of the petition at #10.
1. CONTRARY TO THE WELFARE. The precise language "contrary to the welfare" does not have to be included in the court order, but the order must include language to the effect that remaining in the home would be contrary to the child's welfare, safety or best interests. Indicate "YES" or "NO".
For a child who enters care prior to March 27, 2000: The judicial determination regarding "contrary to the welfare" must result from court proceedings that are initiated no later than six months from the date the child is removed from home, consistent with DAB 1508. If more than six months have elapsed and there is no judicial determination, the response to this question is "NO" and the child is ineligible for title IV-E for this entire stay in foster care.

For a child who enters care on or after March 27, 2000: The judicial determination regarding "contrary to the welfare" must be made in the first order that sanctions the child's removal from the home, even if the order is an emergency "pick-up" order. The determination must be child-specific and may not merely reference State statutes governing removals. Absent a court order, the only acceptable alternative documentation is a transcript of the court proceedings. Nunc pro tunc orders and affidavits are not acceptable. If the response to this question is "NO", the child is ineligible for title IV-E for this entire stay in foster care.
IS THERE A COURT ORDER THAT ADDRESSES REASONABLE EFFORTS. The precise language "reasonable efforts" does not have to be included in the court order, but the order must contain language to the effect that reasonable efforts were made.

For a child who enters care prior to March 27, 2000: The judicial determination that reasonable efforts were made to prevent removal OR that reasonable efforts were made to reunify the child and family satisfies the reasonable efforts requirement. If both determinations are made, record the date of each determination.

For a child who enters care on or after March 27, 2000: The judicial determination that reasonable efforts to prevent removal were made or were not required must be made no later than 60 days from the date of the child's removal from home. The determination must be child-specific and may not merely reference State statutes pertaining to removals. Absent a court order, the only acceptable alternative documentation is a transcript of the court proceedings. Nunc pro tunc orders and affidavits are not acceptable.

13a. Record the date of the court order that addresses reasonable efforts to prevent removal.
13b. Record the date of the court order that addresses reasonable efforts to reunify.

D. VOLUNTARY PLACEMENTS
WAS THE CHILD'S REMOVAL PURSUANT TO A VOLUNTARY PLACEMENT AGREEMENT. For title IV-E eligibility purposes, a child must be removed from home pursuant to either a court order or a voluntary placement agreement. Title IV-E payments may be made only on behalf of a child who is in foster care pursuant to a voluntary placement agreement for the first 180 days of the foster care placement, unless there is a judicial determination that continued voluntary placement is in the child's best interests.
WAS THE VOLUNTARY PLACEMENT AGREEMENT SIGNED BY PARENT/LEGAL GUARDIAN AND THE AGENCY REPRESENTATIVE(S). A valid voluntary placement agreement must be signed by the parent or legal guardian and the title IV-B/IV-E agency representative(s).

15a. Record the date that the voluntary placement agreement was signed by the parent/legal guardian and the agency representative(s). If signings occurred on different dates, record the date of the final signature. The date that the voluntary placement agreement is signed is required because Federal Financial Participation (FFP) cannot begin until the first day of the month in which all eligibility requirements have been satisfied. In the case of a child who is voluntarily placed into care, satisfying all eligibility requirements includes a voluntary placement agreement that is signed by the parent or legal guardian and the agency representative.
IS THERE A JUDICIAL DETERMINATION REGARDING THE CHILD'S BEST INTEREST WITHIN 180 DAYS OF THE DATE OF PLACEMENT. A State can claim FFP for up to 180 days for a child who is removed pursuant to a voluntary placement agreement in accordance with its State plan. If more than 180 days have elapsed since the date of the child's placement in foster care pursuant to a voluntary placement agreement, there must be a judicial determination to the effect that this placement is in the best interests of the child. If more than 180 days have elapsed and there has been no such determination, the child's eligibility for FFP ceases on the 181st day. If fewer than 180 days have elapsed since the child's date of placement, check N/A.

16a. Record the date of the judicial determination regarding the child's best interest.

E. ONGOING JUDICIAL ACTIVITY. Disallowances will be taken for any case that does not meet this requirement after March 27, 2001.
IS THERE A JUDICIAL DETERMINATION REGARDING REASONABLE EFFORTS TO FINALIZE THE PERMANENCY PLAN WITHIN 12 MONTHS OF THE DATE THE CHILD IS CONSIDERED TO HAVE ENTERED FOSTER CARE. In order for a child to be eligible for title IV-E payments, there must be a judicial determination that reasonable efforts were made to finalize the child's permanency plan in effect, which may include reunification, adoption, legal guardianship, placement with a fit and willing relative, or another planned permanent living arrangement. The date by which a judicial determination of reasonable efforts to finalize the permanency plan must be made is no later than 12 months from the date the child is considered to have entered foster care. This requirement may also be satisfied by a judicial determination that reasonable efforts were made to reunify child and family. A "N/A" response to this item means that 12 months have not elapsed since the date the child is considered to have entered foster care.

17a. If applicable, record the date of the court order that addresses reasonable efforts to finalize the permanency plan. If a judicial determination was due and was not made, the child becomes ineligible for title IV-E from the end of the 12th month following the date the child is considered to have entered foster care. The child remains ineligible until such a judicial determination is made.
IS THERE A SUBSEQUENT JUDICIAL DETERMINATION REGARDING REASONABLE EFFORTS TO FINALIZE THE PERMANENCY PLAN AT LEAST ONCE WITHIN EACH 12-MONTH PERIOD FOLLOWING THE INITIAL DETERMINATION. In order to sustain ongoing title IV-E foster care eligibility, there must be a judicial determination every 12 months subsequent to the initial judicial determination of reasonable efforts to finalize the permanency plan while the child is in foster care. If this judicial determination is not made within the specified time frame, the child becomes ineligible from the end of the month in which the most recent judicial determination of reasonable efforts to finalize a permanency plan was due, but not made, and remains ineligible until such a judicial determination is made. A "N/A" response to this item means 12 months have not elapsed since the initial reasonable efforts determination was made.

18a. If applicable, record the date(s) of the subsequent court order(s) that address(es) reasonable efforts to finalize the permanency plan.

F. AFDC ELIGIBILITY
DATE CHILD LAST LIVED WITH PARENT/SPECIFIED RELATIVE. Record the date the child last lived with the specified relative from whom s/he was removed. A specified relative is defined at 45 CFR 233.90(c)(1)(v). A child may be considered to meet the requirement of living with one of the relatives specified in the Social Security Act if the child is with a parent or person in one of the following groups: (1) any blood relative, including those of half-blood, and including first cousins, nephews, or nieces; persons of preceding generations as denoted by prefixes of grand, great, or great-great; (2) stepfather, stepmother, stepbrother, and stepsister; (3) persons who legally adopt a child or the child's parent as well as the biological and other legally adopted children of such persons, and other relatives of the adoptive parents in accordance with State law; and (4) spouses of any persons named in the above groups, even after the marriage is terminated by death or divorce. See IM-92-04.
WAS THE CHILD LIVING WITH THE SPECIFIED RELATIVE WITHIN 6 MONTHS OF THE INITIATION OF COURT PROCEEDINGS OR THE VOLUNTARY PLACEMENT AGREEMENT. The court order removing the child must have been initiated, that is, the petition filed or a voluntary placement agreement signed, no longer than 6-months after the child was living with the specified relative from whom s/he was removed. To be eligible for title IV-E, a child must be eligible for AFDC at home in the month the voluntary placement agreement was signed or the petition was filed. If this is not the case, the statute allows a 6-month period during which the child may reside with an interim caretaker and still be eligible for title IV-E. Indicate "YES" or "NO". If more than 6 months have elapsed from the date of the petition and the date child last lived with the specified relative, the child is ineligible for title IV-E.
WAS THE CHILD LIVING WITH AND REMOVED FROM THE SAME SPECIFIED RELATIVE. If "NO", the child is ineligible for title IV-E.
ELIGIBILITY FOR AFDC AT REMOVAL. Using its criteria in effect in its July 16, 1996 Title IV-A State plan, (OR, IF REMOVAL WAS PRIOR TO THE EFFECTIVE DATE OF PRWORA, the title IV-A State plan in effect at the time) the State must document that the child was removed from a specified relative, and that the child was financially needy and deprived of parental support at removal. Deprivation must be by reason of death, absence, physical or mental incapacity of one parent or the unemployment of the principal wage earner. The reviewer is not responsible for making the determination of AFDC eligibility, but for verifying, based on the documentation that is provided, that the State made or did not make the determination. If the child is not eligible for AFDC, the child is ineligible for title IV-E from the beginning of this placement episode.

22a. Was financial need established’ Indicate "YES" or "NO".
22b. Was deprivation of parental support or care established’ Indicate "YES" or "NO".
WAS THE CHILD'S ELIGIBILITY REDETERMINED. If the child was in care less than one year prior to the period under review, the response to this question is N/A. For a child in foster care for longer than one year, the State must document annually that the child continues to be financially needy and deprived of parental support or care, using the State's criteria in effect in its July 16, 1996 title IV-A State plan. If more than one year has elapsed and no redetermination was done, the State must re-construct AFDC eligibility or the child is ineligible for title IV-E.

23a. Record the date of the redetermination.
DOES FINANCIAL NEED EXIST THROUGHOUT THE PERIOD UNDER REVIEW. Using the State's mechanism to document the child's eligibility at redetermination, respond YES or NO. If NO, record the period of time during which the child IS NOT financially needy.
DOES DEPRIVATION EXIST THROUGHOUT THE PERIOD UNDER REVIEW. Using the State's mechanism to document the child's eligibility at redetermination, respond YES or NO. If NO, record the period of time during which the child IS NOT deprived of parental support or care.

G. STATE AGENCY RESPONSIBILITY FOR PLACEMENT AND CARE
AGENCY RESPONSIBILITY FOR PLACEMENT/CARE. The title IV-E agency (or another public agency, including an Indian tribe, with which the title IV-E agency has a written agreement, which is in effect) must have responsibility for placement and care of the child. The court order or voluntary placement agreement must indicate that the agency has this responsibility. A response of YES to this item indicates that the agency holds this responsibility for the entire review period. (Note that the reviewer must verify that the title IV-E agency has a bonafide agreement in effect with the agency for the time period under review in those instances where another public agency has responsibility for placement and care of the child.) If the response to this question is NO, record the period during which the title IV-E agency does not have responsibility for placement and care of the child.
AGENCY DOES NOT HAVE P/C RESPONSIBILITY. Record any period of time when the title IV-E agency or agreement agency(ies) DOES NOT have placement and care responsibility. Child is ineligible during this time period.
NAME OF AGENCY. Record the name of the agency (ies) with responsibility for placement and care of the child during the review period.

H. PLACEMENT IN A LICENSED HOME OR FACILITY. This section is to be completed for each home or facility.

X3-X6. Record provider information for each home/facility during the period under review.
CHILD'S DATE OF PLACEMENT IN HOME/FACILITY. Record the date that the child was placed in EACH facility that is included in the period under review.
DATE OF CHILD'S DEPARTURE FROM HOME/FACILITY. Record the date that child left this facility, if applicable.
TYPE OF FOSTER CARE FACILITY. The reviewer is to determine if the child is placed in one of the following title IV-E eligible facilities: foster family home; group home; public institution of 25 children or fewer; or private non-profit or for-profit child care institution. A facility that does not fall into one of these categories is not eligible for Federal matching funds. Child placed in facilities such as detention centers, hospitals, and public institutions of more than 25 children are ineligible for title IV-E. "Other" category should be used when child is not in one of the placements indicated above. If placement is "Other," provider is ineligible.
LICENSED OR APPROVED FACILITY. The license must show that the home or facility is licensed during the child's placement there. Indicate whether or not the foster care home or facility, regardless of type, was licensed or approved. The terms "licensed" and "approved" are used here to refer to facilities that meet all of the State's standards for full licensure or approval. (No disallowances will be taken from 3/27/00-9/27/00 for homes that were licensed prior to 3/27/00 that do not meet full licensure status.)

32a. PERIOD OF LICENSURE. Record the dates of the period of licensure or approval of the facility that encompass the period under review.

32b. If the response to question 32 is NO, indicate the dates when the facility is NOT licensed or approved.

I. SAFETY REQUIREMENTS OF PROVIDER. This section is to be completed for each home or facility.
OPT-OUT PROVISION. Has this State opted out of the criminal records check requirement for foster and adoptive parents’ If YES, proceed to #35. If NO, continue to #34.
SATISFACTORY COMPLETION OF CRIMINAL RECORDS CHECK. Unless the State has opted out of the criminal records check requirement, the State must provide documentation that criminal records checks have been conducted with respect to prospective foster and adoptive parents. The licensing file must contain documentation of the criminal records checks. A response of N/A indicates the child is not placed in a foster family home or a pre-adoptive home.
SAFETY REQUIREMENTS FOR FOSTER/ADOPTIVE HOMES WHEN STATE HAS OPTED-OUT OF CRIMINAL RECORDS CHECK. In all cases where the State opts out of the criminal records check requirement, the licensing file for that foster or adoptive family must contain documentation that verifies that safety considerations with respect to the caretaker(s) have been addressed. A response of N/A indicates the child is not placed in a foster family home or a pre-adoptive home OR that the State has not opted out of the criminal records check requirement.
SAFETY REQUIREMENTS FOR STAFF/CARETAKERS IN CHILD CARE INSTITUTIONS. In order for a child care institution to be eligible for title IV-E funding, the licensing file for the institution must contain documentation which verifies that safety considerations with respect to the staff of the institution have been addressed. A response of N/A indicates the child is not placed in a child care institution.

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After checklist is completed, determine if child is eligible for the entire sample review period and if provider is eligible for entire sample review period, and so indicate at the top of the checklist. If the child or provider has any periods of ineligibility, these should be recorded on the INELIGIBLE CHART and attached to this instrument.

Attachment

Title IV-E Foster Care Eligibility Review - HTML or PDF (16 KB)

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