ADOPTION ASSISTANCE AGREEMENTAdoption Assistance Agreement • August 17th, 2005
The following agreement has been entered into by and between the Department of Children and Family Services, hereinafter called “the Department,” and
Adoption Assistance Agreement:Adoption Assistance Agreement • June 14th, 2022
Heartland for Children has a Post Adoption Services worker that is available to assist adoptive parents. It is vital if an adoptive family feels they may need counseling or other service for their family, they contact the post adoptions worker to discuss and
COMMONWEALTH OF KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES DEPARTMENT FOR COMMUNITY BASED SERVICES ADOPTION ASSISTANCE AGREEMENT NON-RECURRING ADOPTION EXPENSESAdoption Assistance Agreement • January 6th, 2021
THIS AGREEMENT, made and entered into as of the 1st day of , 2 , by and between the Commonwealth of Kentucky, Cabinet for Health and Family Services, Department for Community Based Services, hereinafter referred to as the Cabinet, and
Tennessee Department of Children’s Services Adoption Assistance Agreement Title IV-E Fostering Connections, Effective on or after January 1, 2023 for Youth 16 or olderAdoption Assistance Agreement • December 29th, 2022
Adoptive Parent Last Name: Adoptive Parent First Name: Adoptive Parent Address: Adoptive Parent Email Address: Adoptive Parent Phone Number:
ADOPTION ASSISTANCE AGREEMENT BETWEEN THE DEPARTMENT OF CHILDREN AND FAMILIES AND ADOPTIVE PARENTS REGARDING SUBSIDY PAYMENTS AND SERVICESAdoption Assistance Agreement • December 6th, 2020
Type and Amount of Subsidy / Service Medicaid Non-Recurring Adoption Expenses Projected Costs Reason for Medical Subsidy
ADOPTION ASSISTANCE AGREEMENT BETWEEN THE DEPARTMENT OF CHILDREN AND FAMILIES AND ADOPTIVE PARENTS REGARDING SUBSIDY PAYMENTS AND SERVICESAdoption Assistance Agreement • November 25th, 2020
Type and Amount of Subsidy / Service Maintenance: IV-E $ Maintenance: NON IV-E $ Maintenance: IV-E $ MEDICAID ONLY Maintenance: NON IV-E $ MEDICAID ONLY TANF $ Medical Assistance $ Medicaid? Non-Recurring Adoption Expenses Projected Cost Reason for Medical Assistance
VIRGINIA ADOPTION ASSISTANCE AGREEMENTAdoption Assistance Agreement • April 9th, 2015
This agreement is entered into by , the local department, and , the “adoptive parent(s),” and , the licensed child placing agency (LCPA) when this child is in its custody, on behalf of this child named above.
ADOPTION ASSISTANCE AGREEMENT BETWEEN THE DEPARTMENT OF CHILDREN AND FAMILIES AND ADOPTIVE PARENTS REGARDING SUBSIDY PAYMENTS AND SERVICESAdoption Assistance Agreement • February 20th, 2022
Type and Amount of Subsidy / Service Medicaid Yes No Non-Recurring Adoption Expenses Projected Costs Reason for Medical Subsidy Medical Care Psychiatric Treatment Surgery Other (specify)
ADOPTION ASSISTANCE AGREEMENTAdoption Assistance Agreement • April 2nd, 2019 • Wisconsin
This document is the initial adoption assistance agreement. The adoptive parent(s) agree that he / she / they intend to adopt the child named above and have signed this document prior to finalization of the adoption for the purposes of receiving adoption assistance payments and / or services for the adopted person under Titles XIX and XX of the Social Security Act from the time of adoptive placement.
Creating an Adoption Assistance AgreementAdoption Assistance Agreement • June 19th, 2020
Note: To create an agreement, the child must have an approved Adoption Assistance Application for Decision, an approved out of home placement, an approved Child & Adolescent Needs & Strengths (CANS), and a Foster Care Rate.
Adoption Assistance Agreement For State Funded Subsidy PaymentsAdoption Assistance Agreement • October 15th, 2009
To define the parameters for an Adoption Assistance Agreement regarding subsidy payments funded by the state. The form identifies the adoptive parents and child(ren). It establishes the amount of the subsidy and the period it will be in effect. The form also specifies the nature of the problem(s) that justify the subsidy.
VIRGINIA ADOPTION ASSISTANCE AGREEMENTAdoption Assistance Agreement • December 19th, 2017
This child has the following special needs documented by qualified professional and established by the local department.
ADOPTION ASSISTANCE AGREEMENT BETWEEN THE DEPARTMENT OF CHILDREN AND FAMILIES AND ADOPTIVE PARENTS REGARDING SUBSIDY PAYMENTS AND SERVICESAdoption Assistance Agreement • August 16th, 2022
Certification: Initial Update Region: Effective Date: Name of Prospective Parent 1: Name of Prospective Parent 2: Address of Adoptive Parents: Telephone: Type and Amount of Subsidy/ Service Medicaid? Non-Recurrent Adoption Expenses Projected Cost Reason for Medical Assistance Maintenance: IV-E $ Yes No Legal Cost $ Medical Care Psychiatric Treatment SurgeryOther (specify): Maintenance: NON IV-E $ Other Non-recurring Expenses $ Maintenance: IV-EMEDICAID ONLY $ $ $ Maintenance: NON IV-EMEDICAID ONLY $ $ $ TANF $ Total Projected Cost: $ Medical Assistance $ Other Services Specify: Does the adoptive parents(s) and child elect to opt into the Extension of Maintenance Adoption Subsidy Assistance Program? Yes No N/AOnly Applicable to a child who is age 16 or 17 when the initial agreement is signed.
AGREEMENT PROVISIONSAdoption Assistance Agreement • December 19th, 2022
State law requires the Michigan Department of Health and Human Services (MDHHS) enter into the following agreements; DHS-4113, Adoption Assistance Agreement, DHS-4814, Nonrecurring Adoption Expenses Agreement, and DHS-3013, Adoption Medical Subsidy Agreement with adopting parent(s) as a condition of eligibility for:
The following agreement has been entered into by and between: State Agency/Other Relevant AgenciesAdoption Assistance Agreement • April 20th, 2022
and have signed this document prior to finalization of the adoption for the purpose of receiving adoption assistanc payments and/or services for the child under (Title IV-E) or (State Adoption Assistance), (Non-recurring adoption expenses), (Medicaid).
