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Residential Child Care Contracts

Form Number Form Name
2282cx Residential Child-Care Contract Amendment FY2017 (effective September 1, 2016)
2282IPTP Intensive Psychiatric Transition Program Services Residential Child-Care Contract Amendment FY 2017 (effective September 1, 2016)

Sample Letters

Contract-Related Forms

Form Number Form Name
2031 Signatory Authority Designation
2033RCC Subcontractor Documentation Form
2033a-RCC Subcontractor Process (PDF Document)
2069 Caregiver Declaration for International Travel Form (PDF Document)
2085E Education Decision-Maker Form
2128 24 Hour Awake Caregiver Supervision Plan
2109 Residential Child Care Discharge Notice Form
2279 Placement Summary
2403 Medical/Dental/Vision Examination Form / Instructions
2500 Transition Plan Form & Instructions
2530 Rights of Children and Youth in Foster Care (PDF Document)
2530s Derechos de los niños y jóvenes bajo cuidado temporal (PDF Document)
3300 Single Child's Plan of Service / Instructions
9007RCC Internal Control Structure Questionnaire (ICSQ) for Residential Child Care
  Contractor Information

Supervised Independent Living (SIL) Forms

Form Number Form Name
PCS-101SIL Contractor Information Form
PCS-102SIL Contracting Entity and List of Staff, Subcontractors, and Volunteers
2609-AP Supervised Independent Living Physical Setting Walk Through Check List- Apartment Setting
2609-CD Supervised Independent Living Physical Setting Walk Through Check List- College Dorm Setting
2609-NCD Supervised Independent Living Physical Setting Walk Through Check List- Non-College Dorm Setting
2609-HH Supervised Independent Living Physical Setting Walk Through Check List- Host Home Setting
2609-SH Supervised Independent Living Physical Setting Walk Through Check List- Shared Housing Setting
2661-SIL Weekly Status Report For Residential Contracts Supervised Independent Living
Weekly Status Report For Residential Contracts Supervised Independent Living

Medical Consent Forms

Form Number Form Name
2085-B Designation of Medical Consenter (PDF Document)
2094 Summary of Child's Medical Care (PDF Document)
4526 Psychotropic Medication Treatment Consent Form

Other Forms

Form Number Form Name
2069 Caregiver Declaration for International Travel Form (PDF Document)
2530 Rights of Children and Youth in Foster Care
2530s Derechos de los niños y jóvenes bajo cuidado temporal (PDF Document)