Current through Register No. 13, March 27, 2025
(a) DCYF shall
forward an application packet to child-placing agency applicants meeting the
requirements of He-C 6448.04 which includes the
following:
(1) Form 2611 "Application For
Child-Placing Agency License" (October 2019); and
(b) A representative of the
governing body of the child-placing agency applicant shall sign and date the
"Certification" of Form 2611 "Application For Child-Placing Agency License"
(October 2019) certifying the following:
"As a representative of the governing body, I certify
that:
The governing body has authority over and responsibility
for the operation and policy of the applicant agency;
The governing body is comprised of no less than 7 persons
who have knowledge of the services provided; and
The governing body does not include staff members of the
applicant agency, not have any proprietary relationship with liquid or fixed
assets of any applicant agency"
(c) In addition to the requirements in (a)
and (b) above, the administrator of the applicant agency shall sign and date
the "Authorization/Statement of Understanding" of Form 2611 "Application For
Child-Placing Agency License" (October 2019) which affirms:
"I have reviewed Administrative Rule He-C 6448 and shall
adhere to the rule as a licensed child-placing agency. I hereby acknowledge
that DCYF personnel will be provided with access to the child-placing agency's
case records, personnel files, and other agency records in accordance with
He-C
6448.07(a) .
I authorize the NH Division for Children, Youth and
Families (DCYF) to conduct reviews to determine the agency's compliance with
Administrative Rule He-C 6448. I further understand that DCYF has the right to
verify information contained in this application.
The information contained in this application is correct to
the best of my knowledge."
(d) In addition to the requirements in (a) -
(c) above, all agency personnel, including volunteers and any member of the
governing board that has regular contact with children, shall submit:
(1) A completed and notarized form "Criminal
History Record Information Release Authorization Form" (DSSP256) directly to
the New Hampshire department of safety - division of state police with Section
II completed to authorize the release of the person's criminal records, if any,
to the department; and
(2) A
completed and notarized form 2501 "DCYF Central Registry Name Search
Authorization Release of Information to Third Party" (October 2019) to the
department and the applicant shall certify to the following:
"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
170-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 below that is not governed
under these laws will not be sent the results."
(e) In addition to the requirement in (a) -
(d) above, the applicant shall submit documentation of the present need for the
proposed child-placing agency that includes:
(2) Population to be served;
(3) Geographic area to be served;
and
(4) Documents or statements of
requested delivery of service from DCYF or other child-placing agency such as a
request for proposal;
(f) In addition to the requirements in (a) -
(e) above, the applicant agency shall submit the following attachments with
Form 2611 "Application For Child-Placing Agency License" (October 2019):
(1) Written statements of philosophy and
policy for agency operations that addresses:
d. Reporting of child abuse and neglect in
accordance with RSA 169-C;
e.
Discipline of children in care;
f.
Confidentiality of files and, records and information gathered in accordance
with RSA
170-E:28,
170-E:29,
170-E:33 and
RSA
170-E:42;
g. Minimum educational or experiential
requirements for staff;
h. Limits
on the number of cases per caseworker;
i. Documentation that criminal record and
central registry checks have been obtained on every staff member;
j. Methodology for assessment and evaluation
of programs;
k. Provisions for the
permanent retention of records pertaining to the placement of children for
adoption, including maintenance of such records in the event that a licensed
agency ceases to operate as a licensed child-placing agency.
l. The appropriateness, safety, environmental
health, and general adequacy of the premises, including maintenance of adequate
fire prevention and health standards conforming to state laws and municipal
codes, to provide for the physical comfort, health and care of children
received;
m. Provisions for food,
clothing, educational opportunities, program, equipment, and individual
supplies to assure the health and the physical and mental development of
children served;
n. Provisions to
safeguard the legal rights of children served;
o. Maintenance of records pertaining to the
admission, progress, health and discharge of children;
p. Filing of reports with the department,
including format, frequency, and content of such reports;
q. Protection and fostering of the particular
religious faith of the children served, where applicable;
r. Duties and responsibilities of the board
of directors or other governing body of the child-placing agency with respect
to compliance with residential care and child-placing agency Licensing
beginning at RSA
170-E:24 and the related standards according
to He-C 6448.
(2)
Written personal standards that include:
a.
Titles for each position defining the salary scale, duties, and lines of
authority;
b. Job descriptions and
qualifications of the administrator and casework supervisor which shall meet or
exceed the requirements set forth in
He-C
6446.04(c) and (f) ;
c. A description of employee
benefits;
d. Opportunities for
growth through supervision, orientation, in-service training, and staff
development including competency-based courses pursuant to
He-C
6446.19;
e. Annual evaluations of the work and
performance of each staff member that includes provision for employee
participation in the evaluation process;
f. A description of the termination
procedures established for resignation, retirement, or discharge; and
g. A grievance procedure for employees.
(g) In
addition to the requirements in (a) - (f) above, the applicant agency shall
submit the following attachments with Form 2611 "Application For Child-Placing
Agency License" (October 2019):
(1) A copy of
the child-placing agency applicant's charter, articles of incorporation,
by-laws, or other policy documents demonstrating the legal authority for
operating in NH;
(2) A copy of the
most recent needs assessment conducted pursuant to He-C 6448.08(e);
(3) Copy of a Certificate of Good Standing
from the New Hampshire secretary of state;
(40 Fee schedules for adoption services provided by the
child-placing agency;
(5)
For child-placing agencies in operation for at least 3 years, attach a copy of
the most recent audited financial statements, and budgets for the last 3
years;
(6) For child-placing
agencies in operation for less than 3 years, attach documentation of funding
source, budget, staffing, fee schedules and contingency funds that demonstrates
that the agency has the fiscal capacity to operate for at least 6
months;
(7) A copy of the agency
specific handbook for foster and adoptive parent applicants that describe the
requirements, policies, procedures, and forms; and
(8) A copy of the current listing of
personnel, including volunteers, and an organizational structural chart noting
supervisory relationships and the reporting hierarchy of the child-placing
agency.
#7866, eff 4-2-03; ss by #9895, eff
4-2-11
