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Appendix 1530-E: Title IV-E Eligibility Checklist

CPS June 2013

To determine if the child is Title IV-E eligible answer the following questions.

Requirements

Yes

No

1)  Is the child a U.S. citizen, legal permanent resident, or qualified alien, or was Evaluative Conclusion used to verify the child's citizenship status?

 

 

2a)  Did parental deprivation exist in the home of removal?

 

 

2b)  If YES to 2a), mark the basis for deprivation below:

¨ Death or Absence of a parent(s) 

¨ Incapacity of a parent(s) 

¨ Primary Wage Earner (PWE) Underemployment based upon either:

¨ PWE worked less than 100 hours a month on average, or

¨ PWE monthly gross earned income is equal to or less than the applicable amount on the Income Guidelines for Underemployed Parent chart at Appendix 1530-D: Income Guidelines for Underemployed Parent for Parental Deprivation.

 

 

3a)  Did the child meet the domicile requirement? 

 

 

3b)  If YES to 3a, indicate how domicile was met:

¨ The child was physically removed by court order from a parent or specified relative.

¨ The child lived with a parent or specified relative with managing conservatorship of the child at some time during the 6 months before the month the court proceedings to remove the child were initiated.

 

 

4) Did the certified group’s income meet the applicable 185% and 100% of AFDC Needs Standard Income limits on the AFDC Income Limits chart at Appendix 1530-C: AFDC Needs Standard Income Limits?

 

 

5)  Are the certified group's resources under the $10,000 limit?

 

 

6)  Did the first court order addressing the child's removal contain the judicial determination that removal was in the child's best interest or that remaining in the home was contrary to the welfare of the child?

 

 

7)  Was there a judicial determination that reasonable efforts were made to prevent removal within 60 days of the child's court-ordered removal from the home?

 

 

8)  Did a court order give DFPS responsibility for the child's placement and care or managing conservatorship of the child?

 

 

If "yes" was answered to all of the questions above, the child is Title IV-E eligible.

If "no" was answered to any question above, the child is not Title IV-E eligible.

 

_____________________________________________________
Eligibility Specialist

 

_____________________
Date

 

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