Common Contracts
1 similar Adoption Subsidy Agreement contracts
Adoption Subsidy AgreementAdoption Subsidy Agreement • March 20th, 2020
Agreement Type: Presubsidy/preadoptive Initial RevisedIV-Eligible Yes No Subsidy InitialIV-Eligible Revised Yes No Future Needs 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 At risk of developing an emotional or behavioralDiagnosed intellectual disability disabilityDiagnosed psychiatric condition At risk of developing a medical or physical Diagnosed behavioral or emotional disorder disabilityAge five and older Is at risk of developing an intellectual disabilitySibling group of three or more 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/rehabilitative needs Non
