Current through all regulations passed and filed through September 16, 2024
(A) The public
children services agency (PCSA) shall maintain a separate case record for each
AA case.
(B) The case record shall contain
documentation which supports the PCSA's actions in determining eligibility for
AA. The case record shall include the following information, when applicable:
(1) A copy of the signed JFS 01451 "Title
IV-E Adoption Assistance Application" (rev. 12/2015).
(2) A copy of the AA eligibility determination in the statewide
automated child welfare information system (SACWIS).
(3) A copy of each signed
JFS 01451-B "Title IV-E Adoption
Assistance Annual Assurance of Legal Responsibility, School Attendance and
Eligibility for Continued Medicaid Coverage"
(rev. 7/2019).
(4) A copy of the PCSA's petition to the
court which led to the child's removal from the specified relative.
(5) A copy of the court order which resulted
in the child's removal from a specified relative and which contains a judicial
determination to the effect that continuation in the home would be contrary to
the welfare of the child and that placement is in the best interest of the
child.
(6) A copy of the signed JFS
01645 "Agreement for Temporary Custody of Child" (rev. 4/2006) along with a
copy of a court determination that continuation in the home would be contrary
to the welfare of the child and that the placement is in the best interest of
the child.
(7) A copy of the court
order committing the child to the permanent custody of an Ohio PCSA or Ohio
private child placing agency (PCPA), or a copy of the JFS 01666 "Permanent
Surrender of Child" (rev. 10/2013). In cases where the child initially entered
permanent custody as the result of the execution of a JFS 01666, there must
also be a copy of a court determination that continuation in the home would be
contrary to the welfare of the child and that the placement is in the best
interest of the child.
(8) A copy
of the signed JFS 01654 "Adoptive Placement Agreement" (rev. 2/2017).
(9)
Initial
child
study
inventory.
(10) A copy of the JFS
01616 "Social and Medical History" (rev. 6/2009).
(11) A copy of the JFS 01673 "Assessment for
Child Placement (Homestudy)" (rev.12/2014) or another state's approved child
with special needs homestudy.
(12)
A copy of the JFS 01673A "Ohio Department of Job and Family Services Child
Characteristics Checklist for Foster Care and/or Adoption" (rev.
12/2006).
(13) A copy of the JFS
01689 "Documentation of the Placement Decision-Making Process" (rev.
4/2017).
(14) A copy of the JFS
01692 "Application for Adoption of a Foster Child or Sibling Group" (rev.
12/2014).
(15) If the basis for
determination of AA eligibility is meeting supplemental security income (SSI)
eligibility requirements, a copy of the SSI voucher or a copy of any other
official documentation verifying SSI eligibility.
(16) If the basis for determination of AA
eligibility is ADC-relatedness, copies of all documentation used for the
determination.
(17)
The
eligibility determination for the child of a minor parent who is eligible for a
Title IV-E foster care maintenance (FCM) payment.
(18)
If
the basis for determination for AA eligibility is that the child was placed in
the custody of the PCSA as a result of a JFS 01645 or JFS 01666, then copies of
all documentation used for determination.
(19) A copy of the ODM 06612 "Health
Insurance Information Sheet" (rev. 9/2016) as completed by the adoptive
parent(s).
(20) A copy of the
adoption petition filed with the court.
(21) A copy of the adoption
finalization.
(22) A copy of the
signed JFS 01453 "Title IV-E Adoption Assistance
Agreement" (rev. 7/2019) between the adoptive parents and the PCSA and
any amendments.
(23) Documentation
of current eligibility for AA, and in a prior finalized adoption.
(24) Copies of each signed
JFS
01451-B
.
(25) A copy of the documentation evidencing
repayment of any identified AA overpayment.
(26) A copy of all state hearing, administrative appeal and judicial
review documentation
.
(27) A copy of the JFS 01470 "Title IV-E Adoption Assistance State Mediation
Conference Request" (rev. 7/2019).
(28) A copy of the interstate compact and
adoption medical assistance forms.
(C) For applications received from an
adoptive parent(s) who resides out of state, the case record shall include a
copy of forms which contain, at a minimum, the information required by the JFS
01673, JFS 01692 and child study inventory.
(D) In order to protect confidentiality of
adoption records, the dates of the documents listed in paragraphs (B)(3) to
(B)(6) of this rule may be included in the AA case record in place of copies of
the court order, JFS 01645, JFS 01666, or petition for adoption. For auditing
purposes these documents shall be provided upon request. Provision of these
dates by the PCSA shall be recognized as evidence that copies of the legal
records exist. The following information shall be provided on the child
services agency (CSA) or PCSA's letterhead.
(1) Each document shall be clearly
identified.
(2) The effective date
of each record.
(3) The PCSA
representative's signature, confirming that the record is on file at the
PCSA.
(E) When
applicable, the PCSA shall contact the PCPA which placed the child for adoption
in order to obtain verification of the date of the documents listed in
paragraph (B) of this rule. Documentation of these dates by the PCPA shall be
recognized as evidence that copies of the legal records exist. For auditing
purposes these documents shall be provided upon request. The following
information shall be provided on the PCPA's letterhead.
(1) Each record shall be clearly
identified.
(2) The effective date
of each record.
(3) The PCPA
representative's signature confirming that the record is on file at the
PCPA.
(4)
Pre-adoptive identifying information which is needed
to establish eligibility for AA.
(F) The PCSA and PCPA shall use the
pre-adoptive identifying information when contacting
the public assistance benefits eligibility or referral specialists to request
pertinent information on file, or when contacting the social security
administration to request pertinent information about the child's eligibility
for SSI. The PCSA and PCPA shall not provide any information about the child's
new identity or present situation.
(G)
Pursuant to
rule
5101:2-33-23 of the
Administrative Code the adoption assistance case record shall be permanently
retained.
