Common use of Child Information Clause in Contracts

Child Information. Child’s First Name: Child’s Date of Birth: Date Child Freed for Adoption: Date Adoptive Placement Agreement Signed: Date of Disruption from Previous Adoptive Placement (If Any): Date Child Entered Adoptive Home: Full Name and Address of Adoptive Parent(s) Adoptive Parent: Adoptive Parent: Address: City: County:‌‌‌ State: Zip: Phone: ( ) Ext: Name and Address of Social Services District or Voluntary Authorized Agency with custody and guardianship of child Name: Address: City: County:‌‌ State: Zip: Case Manager’s Name: Case Manager’s Phone Number: ( ) Ext. Name and Address of Agency of Case Planner (If Applicable) Name: Address City: County:‌‌ State: Zip: Case Planner’s Name: Case Planner’s Phone Number:‌ ( ) Ext. Section II‌ Purpose of the Agreement Both federal and State law require that payments for an adoption subsidy and non-recurring adoption expenses must be made in accordance with a written agreement. This Agreement will enable the social services district worker and/or the agency worker to determine whether an adoption subsidy and non-recurring adoption expenses will be provided. New York’s Adoption Subsidy and Non-Recurring Adoption Expenses Programs provide subsidy payments to all parents adopting eligible children without regard to the adoptive parent(s) income. However, there are a number of factors that determine the extent and type of benefits that will be provided. These are explained in the Summary of New York’s Adoption Subsidy and Non-Recurring Adoption Expenses Programs that is attached to this Agreement and is incorporated herein (see Appendix A). This Agreement will clearly spell out the benefits to be provided, and identify the provisions affecting those benefits. It will also specify the circumstances under which the benefits may be changed in the future and whether such changes require a new Agreement and State approval or only an amendment to this Agreement. New York State law provides that an application for an adoption subsidy may be accepted before the child is completely freed for adoption, but final approval of the application may not be granted until the child is completely freed for adoption.

Child Information. Child’s First Name:   Child’s Last Name:   Date Child Placed into Xxxxxx Care:   Date Child Placed with Prospective Relative Guardian(s):   Child’s Date of Birth: Date Child Freed for Adoption: Date Adoptive Placement Agreement Signed: Date of Disruption from Previous Adoptive Placement (If Any): Date Child Entered Adoptive Home:   Full Name and Address of Adoptive Parent(sProspective Relative Guardian(s) Adoptive ParentProspective Relative Guardian: Adoptive Parent  Prospective Relative Guardian:   Address:   City: County:‌‌‌   County:   State:   Zip:   Phone: ( ) Ext  Extension:   Name and Address of Social Services District with care and custody or Voluntary Authorized Agency with custody and guardianship of child named in this Agreement Name:   Address:   City: County:‌‌   County:   State:   Zip:   Case Manager’s Name:   Case Manager’s Phone Number: ( ) Ext.   Extension:   Name and Address of Agency of Case Planner (If Applicable) Name: Address   Address:   City: County:‌‌   County:   State:   Zip:   Case Planner’s Name:   Case Planner’s Phone Number:‌ ( Number:   Extension:   OCFS-4431 (4/2011) Ext. Section II‌ PAGE 2 of 11 SECTION II - Purpose of the this Agreement Both federal and State law require that payments for an adoption subsidy kinship guardianship assistance and non-recurring adoption kinship guardianship expenses must be made in accordance with a written agreement. This Agreement will enable the social services district worker and/or the agency worker to determine whether an adoption subsidy and non-recurring adoption expenses will be provided. New York’s Adoption Subsidy and Non-Recurring Adoption Expenses Programs provide subsidy payments to all parents adopting eligible children without regard to the adoptive parent(s) income. However, there There are a number of factors that determine the extent and type of benefits that will be provided. These are explained in this Agreement and in the Summary of the New York’s Adoption Subsidy York State Kinship Guardianship Assistance and Non-Recurring Adoption Guardianship Expenses Programs that is attached to this Agreement and is incorporated herein (see Appendix A). This Agreement will clearly spell out the benefits to be provided, and identify the provisions affecting those benefits. It will also specify the circumstances under which the benefits may be terminated or the benefits may be changed in the future and whether such changes require a new Agreement and State approval or only an amendment to this Agreement. In addition, this Agreement will address the additional services and assistance for which the prospective relative guardian(s) and the child are eligible and how the prospective relative guardian(s) may apply for such services or assistance. This Agreement will take effect: a) when completed and signed by the prospective relative guardian(s) and by the appropriate social services district and b) when, following the execution of this Agreement, the court issues letters of guardianship to the prospective relative guardian(s) named in this Agreement on behalf of the child named in this Agreement. This Agreement constitutes a contract between the prospective relative guardian(s) and the social services district, subject to federal law, the laws of the State of New York and the regulations of the Office of Children and Family Services (OCFS). The prospective relative guardian(s) must be given a final signed copy of this Agreement. The relative guardian(s) should retain a copy of this Agreement along with the Summary of the New York State law provides that an application for an adoption subsidy may be accepted before the child is completely freed for adoption, but final approval of the application may not be granted until the child is completely freed for adoptionKinship Guardianship Assistance and Non-Recurring Guardianship Expenses Programs.

Child Information. Child’s First Name:   Child’s Last Name:   Date Child Placed into Xxxxxx Care:   Date Child Placed with Prospective Relative Guardian(s):   Child’s Date of Birth: Date Child Freed for Adoption: Date Adoptive Placement Agreement Signed: Date of Disruption from Previous Adoptive Placement (If Any): Date Child Entered Adoptive Home:   Full Name and Address of Adoptive Parent(sProspective Relative Guardian(s) Adoptive ParentProspective Relative Guardian: Adoptive Parent  Prospective Relative Guardian:   Address:   City: County:‌‌‌   County:   State:   Zip:   Phone: ( ) Ext  Extension:   Name and Address of Social Services District With Care and Custody or Voluntary Authorized Agency with custody Custody and guardianship Guardianship of child Child Named in This Agreement Name:   Address:   City: County:‌‌   County:   State:   Zip:   Case Manager’s Name:   Case Manager’s Phone Number: ( ) Ext.   Extension:   Name and Address of Agency of Case Planner (If Applicable) Name: Address   Address:   City: County:‌‌   County:   State:   Zip:   Case Planner’s Name:   Case Planner’s Phone Number:‌ ( Number:   Extension:   OCFS-4431 (02/2018) Ext. Section II‌ PAGE 2 of 13 SECTION II - Purpose of the This Agreement Both federal and State state law require that payments for an adoption subsidy kinship guardianship assistance and non-recurring adoption nonrecurring kinship guardianship expenses must be made in accordance with a written agreement. This Agreement will enable the social services district worker and/or the agency worker to determine whether an adoption subsidy and non-recurring adoption expenses will be provided. New York’s Adoption Subsidy and Non-Recurring Adoption Expenses Programs provide subsidy payments to all parents adopting eligible children without regard to the adoptive parent(s) income. However, there There are a number of factors that determine the extent and type of benefits that will be provided. These are explained in this agreement and in the Summary of the New York’s Adoption Subsidy York State Kinship Guardianship Assistance and Non-Recurring Adoption Nonrecurring Guardianship Expenses Programs that is attached to this Agreement agreement and is incorporated herein (see Appendix A). This Agreement agreement will clearly spell out the benefits to be provided, and identify the provisions affecting those benefits. It will also specify the circumstances under which the benefits may be terminated or the benefits may be changed in the future future, and whether such changes require a new Agreement and State approval agreement or only an amendment to this Agreementagreement. In addition, this agreement will address the additional services and assistance for which the prospective relative guardian(s) and the child are eligible and how the prospective relative guardian(s) may apply for such services or assistance. This agreement will take effect: a) when completed and signed by the prospective relative guardian(s) and by the appropriate social services district and b) when, following the execution of this agreement, the court issues letters of guardianship to the prospective relative guardian(s) named in this agreement on behalf of the child named in this agreement. This agreement constitutes a contract between the prospective relative guardian(s) and the social services district, subject to federal law, the laws of the State of New York and the regulations of the New York State law provides that an application for an adoption subsidy may Office of Children and Family Services (OCFS). The prospective relative guardian(s) must be accepted before given a final signed copy of this agreement. The relative guardian(s) should retain a copy of this agreement along with the child is completely freed for adoption, but final approval Summary of the application may not be granted until the child is completely freed for adoptionNew York State Kinship Guardianship Assistance and Nonrecurring Guardianship Expenses Programs.