Ohio Administrative Code › Title 5101:2 - Division of Social Services › Chapter 5101:2-49 - IV-E Adoption Assistance › Section 5101:2-49-17 - Case record requirements for Title IV-E adoption assistance (AA)

Current through all regulations passed and filed through July 1, 2024
(A) The public
			 children services agency (PCSA) shall maintain a separate case record for each
			 AA case.
(B) The case record shall contain
			 documentation which supports the PCSA's actions in determining eligibility for
			 AA. The case record shall include the following information, when applicable:
(1) A copy of the signed JFS 01451 "Title
			 IV-E Adoption Assistance Application" (rev. 12/2015).
(2) A copy of the AA eligibility determination in the statewide
			 automated child welfare information system (SACWIS).
(3) A copy of each signed
			 JFS 01451-B "Title IV-E Adoption
			 Assistance Annual Assurance of Legal Responsibility, School Attendance and
			 Eligibility for Continued Medicaid Coverage"
			 (rev. 7/2019).
(4) A copy of the PCSA's petition to the
			 court which led to the child's removal from the specified relative.
(5) A copy of the court order which resulted
			 in the child's removal from a specified relative and which contains a judicial
			 determination to the effect that continuation in the home would be contrary to
			 the welfare of the child and that placement is in the best interest of the
			 child.
(6) A copy of the signed JFS
			 01645 "Agreement for Temporary Custody of Child" (rev. 4/2006) along with a
			 copy of a court determination that continuation in the home would be contrary
			 to the welfare of the child and that the placement is in the best interest of
			 the child.
(7) A copy of the court
			 order committing the child to the permanent custody of an Ohio PCSA or Ohio
			 private child placing agency (PCPA), or a copy of the JFS 01666 "Permanent
			 Surrender of Child" (rev. 10/2013). In cases where the child initially entered
			 permanent custody as the result of the execution of a JFS 01666, there must
			 also be a copy of a court determination that continuation in the home would be
			 contrary to the welfare of the child and that the placement is in the best
			 interest of the child.
(8) A copy
			 of the signed JFS 01654 "Adoptive Placement Agreement" (rev. 2/2017).
(9)
									Initial
			 child
									 study
			 inventory.
(10) A copy of the JFS
			 01616 "Social and Medical History" (rev. 6/2009).
(11) A copy of the JFS 01673 "Assessment for
			 Child Placement (Homestudy)" (rev.12/2014) or another state's approved child
			 with special needs homestudy.
(12)
			 A copy of the JFS 01673A "Ohio Department of Job and Family Services Child
			 Characteristics Checklist for Foster Care and/or Adoption" (rev.
			 12/2006).
(13) A copy of the JFS
			 01689 "Documentation of the Placement Decision-Making Process" (rev.
			 4/2017).
(14) A copy of the JFS
			 01692 "Application for Adoption of a Foster Child or Sibling Group" (rev.
			 12/2014).
(15) If the basis for
			 determination of AA eligibility is meeting supplemental security income (SSI)
			 eligibility requirements, a copy of the SSI voucher or a copy of any other
			 official documentation verifying SSI eligibility.
(16) If the basis for determination of AA
			 eligibility is ADC-relatedness, copies of all documentation used for the
			 determination.
(17)
									The
			 eligibility determination for the child of a minor parent who is eligible for a
			 Title IV-E foster care maintenance (FCM) payment.
(18)
									If
			 the basis for determination for AA eligibility is that the child was placed in
			 the custody of the PCSA as a result of a JFS 01645 or JFS 01666, then copies of
			 all documentation used for determination.
(19) A copy of the ODM 06612 "Health
			 Insurance Information Sheet" (rev. 9/2016) as completed by the adoptive
			 parent(s).
(20) A copy of the
			 adoption petition filed with the court.
(21) A copy of the adoption
			 finalization.
(22) A copy of the
			 signed JFS 01453 "Title IV-E Adoption Assistance
			 Agreement" (rev. 7/2019) between the adoptive parents and the PCSA and
			 any amendments.
(23) Documentation
			 of current eligibility for AA, and in a prior finalized adoption.
(24) Copies of each signed
			 JFS
			 01451-B
									.
(25) A copy of the documentation evidencing
			 repayment of any identified AA overpayment.
(26) A copy of all state hearing, administrative appeal and judicial
			 review documentation
									.
(27) A copy of the JFS 01470 "Title IV-E Adoption Assistance State Mediation
			 Conference Request" (rev. 7/2019).
(28) A copy of the interstate compact and
			 adoption medical assistance forms.