Common Contracts
1 similar Adoption Subsidy Agreement contracts
Adoption Subsidy AgreementAdoption Subsidy Agreement • March 20th, 2020
Agreement Type: Presubsidy/preadoptive Subsidy Future Needs Initial Revised Initial Revised IV-Eligible Yes No IV-Eligible Yes No IV-Eligible Yes No Parties to the Agreement: Iowa Department of Human Services Adoptive Parents Address Address Phone No. Phone No. Child: Name Birth Date Placement Date Adoption Date Documented Special Needs Covered by Agreement. Check all that apply. Diagnosed medical disability Diagnosed intellectual disability Diagnosed psychiatric conditionDiagnosed behavioral or emotional disorder Age five and olderSibling group of three or more At risk of developing an emotional or behavioral disabilityAt risk of developing a medical or physical disabilityIs at risk of developing an intellectual disability Summary of Benefits: Maintenance: Daily Subsidy Payment$ Special Daily Allowance$ Total Daily Rate$ Effective Date Medical Assistance: Eligibility: IV-E Not IV-E Effective Date Medical coverage is necessary to meet the child’s medical/rehabilitativ
