State of Connecticut Commission on Child Protection
http://www.ct.gov/ccpa/site/default.asp
Juvenile Matters Hourly Report Form
Name and Address of Attorney or Firm Case Name Name of Person Representing or Mother's Name (Last, First)
Date Case Opened Last Visit w/Client Client Code
Date Closed Case Type Court Location
Docket # or #'s
Month/Day
Number of Hours Worked on Case (To the nearest 1/10)
Detailed Log of Daily Activities Include Court Appearances, and Non-Court Time
Case Benchmarks
TOTAL HOURS TOTAL AMOUNT DUE
0 $0.00
Date:
Signature or Approved Symbol:
The representations contained herein are made under the penalties of false statement. If this form is completed and mailed via internet the acceptance of the form will serve as formal signature. I hereby certify that all information contained herein is true and accurate to the best of my knowledge. I understand that submission of a request for payment containing knowingly false statements subject me to all penalties associated with making such false statements. Form# CCPA-HR-12 rev 7/07
Client Type Child Parent GAL - Child GAL - Parent Grandparent Other Legal Guardian Standby C P G B D R L S
Description of Codes Case Type Negligent/Uncared For Delinquency Family With Service Needs Youth in Crisis Termination of Parental Rights Standby Co-Term Emancipation RPG CP DL FN YC TP S CT EMC RPG
Case Benchmarks
Juvenile Court Codes Bridgeport Danbury Hartford Middletown New Britain New Haven Norwalk Rockville Stamford Torrington Waterbury Waterford Willimantic
BP DB HD MT NB NH NW RV ST TR WB WF WL
PET –W/D PET-Dism.
Petition Withdrawn PetitionDismissed OTCAgreementChild Returned OTCAgreementVested in Relative OTCAgreementSustained OTC-TrialSustained OTC-Trial-Child Returned OTC-TrialVested in Relative Appeal taken by DCF Appeal taken on behalf of Child Appeal taken on behalf of Mother Appeal taken on behalf of Father Neglect- Plea & Disposition Neglect-TrialAdjudication Neglect-TrialDismissed FWSN-Plea & Disposition FWSNDismissed FWSN-TrialAdjudication FWSN-TrialDismissed Permanency Plan Approved Permanency Plan of Adoption Achieved Permanency Plan of Reunification Achieved PP of Transfer of Guardianship Achieved PP of Independent Living PP of Long Term Foster Care w/Relative PP of LTFC with Identified Foster Parent PP of other permanent living arrangement PP not achieved & child ages out. TPR withdrawn by Agreement TPR Consent with Open Adoption TPR Consent without Open Adoption TPR Trial – TPR denied TPR Trial – TPR granted Appeal taken by DCF Appeal taken on behalf of Child Appeal taken on behalf of Mother Appeal taken on behalf of Father Life Long Contact Secured Visit with Child
Family Court Codes
OTC – A – RTN
Bridgeport IS
640
OTC-A-VwR
Hartford IS
641
OTC – A – Sust. OTC – T –Sust. OTC – T –RTN
New Britain IS Middletown IS New Haven IS
642 643 644
OTC-T/S-VwR OTC-Appeal - DCF
Norwich IS Putnam IS
645 646
OTC-Appeal-Child
Rockville IS
647
OTC-Appeal-Mother
Stamford IS
648
OTC-Appeal-Father
Waterbury IS Litchfield IS Ansonia/Milford Danbury Fairfield Stamford/Norwalk New Britian Hartford New London Norwich Litchfield Middlesex AAN DBD FBT FST HHB HHD KNL KNO LLI MMX
650 652
NEG- P/D NEG- T –Adj NEG –T-Dism.
FWSN – P/D FWSN – Dism FWSN- T-Adj. FWSN-T-Dism.
PP-Approved
PP-Ach’vd – Adop
New Haven
NNH
PP-Ach’vd- Reunif.
Meriden
NNI
PP-Ach’vd-T/G
Tolland
TTD
PP-Ach’vd-IL
Waterbury
WWY
PP-Ach’vd-LTFC/R
Windham
WWM
PP-Ach’vd-LTFC/IFP
PP-Ach’vd-Other
PP-N/A-Age Out
TPR-A-W/D
TPR-C w/OA
TPR-C w/o OA TPR-T-Denied. TPR- T-Granted TPR-Appeal - DCF
TPR-Appeal-Child
TPR-Appeal-Mother
TPR-Appeal-Father
LLCS VWC