Current through Register No. 40, October 3, 2024
(a) The applicant
shall complete and submit an application packet that includes the following:
(1) The completed Form 1715 "Application for
Foster Family Care License" (June 2020 edition) acknowledging that:
a. "I/we have reviewed the Administrative
Rule He-C 6446 and will adhere to the rules if I/we are licensed as a Foster
Family Care provider. I/We authorize the NH Division for Children, Youth and
Families (DCYF) to receive the results of the central registry check, the state
registry check, and the out-of-state child abuse and neglect registry
checks.";
b. "I/We understand that:
The Division of Children, Youth and Families examines its
child abuse records and the criminal conviction records of the State Police on
Adoptive/Foster Parent applicants (RSA 170-E:4,
III);
All household members 18 years and older shall be subject
to a criminal records search through the NH state and local police, and through
all other states in which the individual has resided for the preceding 5
years;
All household members 18 years old or older shall be
subject to a Federal Bureau of Investigation fingerprint record check;
Information shared about a foster child's safety, the
caregiver's safety and the appropriateness of the placement, is confidential
(RSA
170-E:9, I(a)(13));
Other information about the child's family, or the
circumstances of his or her placement, must also be kept confidential. This
information was taken from DCYF care records and files whose confidentiality is
protected by federal law. Federal regulations (42 CFR, Part 2) prohibit the
further sharing of this information without obtaining the written consent of
the individual to whom it pertains, or as otherwise permitted by federal
regulations;
Completion of this application does not constitute
acceptance into the foster care family program. It is a statement of intention
only and may be withdrawn at any time; and
DCYF has the right to verify information contained in this
application."; and
c. "I/We
understand the above statements and verify that all statements made are
true.";
(2) The Form 1720
"Fire Department Inspection - One and Two Family Dwelling" (June 2020 edition)
or Form 1720A "Fire Department Inspection - Apartment Building" (June 2020
edition) as applicable, completed in accordance with
He-C
6446.09(f);
(3) The Form 1721 "Home Health Inspection"
(June 2020 edition) completed in accordance with
He-C
6446.09(g);
(4) The completed Form 1717 "Local Law
Enforcement Check" (June 2020 edition) and the applicable Criminal History
Record Information form as identified in Table 5700-1 in Saf-C 5703,
authorizing the licensing agency to conduct a criminal records check and local
law enforcement check for:
a. The foster
parent requesting renewal; and
b.
All household members 18 years or older;
(5) Form 2501 "NH Child Abuse and Neglect
Central Registry Name Search Authorization Release of Information to Third
Party" (June 2020 edition) completed by the foster parent requesting renewal
and all household members 18 years of age or older authorizing the licensing
agency to conduct a central registry check certifying
a. "I acknowledge that the results of this
search can only be released to myself or a Child-Placing Agency pursuant to NH
RSA
170-E, the Department of Health and Human
Services pursuant to NH
RSA
17-G:8-c, or another state's Child Welfare
Agency or Private Adoption Agency pursuant to NH
RSA
169-C:35. I understand and authorize the
results of this search to be provided to the person/agency listed below if in
compliance with the aforementioned laws. Any entity listed below that is not
governed under these laws will not be sent the results."; and
b. "I authorize the below named agency to
receive the results of my registry check. I understand that the results will
not be sent to me."; and
(6) For those applicants and household
members 18 years of age or older who have lived outside the state of New
Hampshire within the past 5 years of application:
a. The results of a state criminal history
records search for each state resided in, as required by
He-C
6446.07; and
b. The results of the child abuse and neglect
registries for each state resided in, as required by
He-C
6446.08.
(b) Each applicant shall provide the
following autobiographical information:
(1) A
description of the applicant's physical and mental health;
(2) A brief history of the applicant's
childhood and family background including identification of family members,
noting those family members with whom the applicant had a close relationship,
and a description of the interactions between family members;
(3) A description of the methods of
discipline used in the applicant's family;
(4) The applicant's childhood memories of
enjoyable periods of time, events, and positive relationships;
(5) The applicant's present contacts with
family members;
(6) The educational
background, including highest degree attained, and areas of training and
expertise;
(7) The employment
history for the last 5 years;
(8) A
description of the applicant's marital status and history, including previous
marriages and divorces, if applicable;
(9) A description of the applicant's
experience, if any, caring for children with special needs;
(10) A description of criminal convictions
and domestic violence petitions or restraining orders, if any;
(11) A description of the foster home and the
neighborhood where the applicant(s) resides;
(12) A description of life in the applicant
foster home, including the routine for housekeeping chores, and identification
of any pets in the home, if applicable;
(13) A description of the way in which the
members of the applicant foster family:
a.
Solve problems;
b. Settle
disputes;
c. Show love and
affection;
d. Show anger;
e. Show sadness; and
f. Share household chores;
(14) A description of the family
activities of the applicant foster family;
(15) A description of the expectations,
hopes, and fears of the applicant foster family; and
(16) The applicant's history of parenting
other people's children.
(c) Each additional adult caregiver residing
in the foster home shall provide the following autobiographical information:
(1) A description of the adult caregiver's
physical and mental health;
(2) A
brief history of the adult caregiver's childhood and family background
including identification of family members, noting those family members with
whom the applicant had a close relationship, and a description of the
interactions between family members;
(3) A description of the methods of
discipline used in the adult caregiver's family;
(4) The adult caregiver's childhood memories
of enjoyable periods of time, events, and positive relationships;
(5) The adult caregiver's present contacts
with family members;
(6) The
educational background, including highest degree attained, and areas of
training and expertise;
(7) The
employment history for the last 5 years;
(8) A description of the adult caregiver's
marital status and history, including previous marriages and divorces, if
applicable;
(9) A description of
the adult caregiver's experience, if any, caring for children with special
needs;
(10) A description of
criminal convictions and domestic violence petitions or restraining orders, if
any;
(11) A description of the
applicant foster home and the neighborhood where the adult caregiver
resides;
(12) A description of life
in the applicant foster home, including the routine for housekeeping chores,
and identification of any pets in the home, if applicable;
(13) A description of the way in which the
members of the applicant foster family:
a.
Solve problems;
b. Settle
disputes;
c. Show love and
affection;
d. Show anger;
e. Show sadness; and
f. Share household chores;
(14) A description of the family
activities of the applicant foster family;
(15) A description of the expectations,
hopes, and fears of the applicant foster family; and
(16) The adult caregiver's history of
parenting other people's children.
(d) An application shall be complete upon
submission of the application packet in (a) above, the autobiographical
information in (b) and (c) above, and the following:
(1) Page 2 of Form 1722 "Medical Information
Statement" (June 2020 edition) completed by a physician or nurse practitioner,
for each applicant and each household member, submitted by either the applicant
or the completing physician or nurse practitioner;
(2) Form 1728 "Pre-Adoptive/Foster Family
Care Financial Statement" (June 2020 edition);
(3) The names and contact information for 5
references, in accordance with the following:
a. Each reference shall be a person who has
known the applicant(s) for more than one year;
b. Of the 5 references, no more than one
shall be from a person related to the applicant(s) by blood or marriage;
c. All 5 references shall be
positive in order to constitute a complete application for licensure;
and
d. All references received
shall become a permanent part of the foster home record and as such shall be
transferred to another child-placing agency if applicable; and
(4) For any foster home in which
the applicant is not the homeowner, a letter of good standing shall be obtained
and submitted from the proprietor of the property or his or her
designee.
(e) If the
information provided on the "Medical Information Statement" is incomplete or
contradictory to other information provided by the applicant and the applicant
is unable to provide information to resolve the conflict, the licensing agency
shall require that the applicant or household member obtain a medical or
psychological evaluation.
(f) Upon
the request of the licensing agency, the applicant shall provide additional
information and references if more information is required to assess the
character and abilities of the applicant.
(g) A licensing agency that is not DCYF shall
use the forms described in this section, except that they may alter the forms
by adding the agency's name, logo, and contact information.
#7184, INTERIM, eff 12-28-99, EXPIRED: 4-26-00
New. #7321, eff 7-22-00; ss by
#8663, eff 6-16-06
