CFS 1800 T G Rev 1 2010 State of Illinois Department of Children and Family Services SUBSIDIZED GU by kjj16796

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									CFS 1800-T-G
Rev. 1/2010                                   State of Illinois
                                 Department of Children and Family Services

                             SUBSIDIZED GUARDIANSHIP (KINGAP)
                                  CASE RECORD CHECKLIST


 Child’s Name:                                                           CYCIS ID#:

                                                                         SACWIS ID#:

 Worker’s Name/Number:

 Date Received:


 Subsidy packet components:
         Pass Sheet from Legal Screening, signed and dated by attorney
         CFS 718- Authorization for Background Check, on youth 13 years and older who are achieving
         Subsidized Guardianship in a licensed home. Original signatures for all youth 13 years and older
         allows licensing to do a check prior to placing OTHER DCFS wards in the home. Youth should
         sign - or if refuses to sign- write refused across the form and sign under the REFUSED.
         POST ADOPTION WILL SUBMIT TO CENTRAL OFFICE OF LICENSING.
         CFS 484 Adoption/Guardianship Tracking Form –OR-(CM-46 & 47)
         CFS 483 Caseworker Permanency Planning Checklist (4 originals)
         CFS 483-1 Caregiver Permanency Planning Checklist (4 originals)
         CFS 1800 A-G Eligibility (4 originals)
         CFS 1800 B-G Application (4 originals)
         CFS 1800 C-G Agreement (4 originals)
         CFS 1800 D, If applicable (4 originals)
         CFS 470-H Information Disclosure Form (4 originals)
         CFS 1800 P Verification of Monthly Subsidy Payment Amount (4 copies)
         CFS 1800-S- Approved Subsidy Maintenance Form (4 copies)
         Title IV-E Eligibility/Benefit Information (4 copies)
         CANTS/LEADS Check with printout (cleared within past 6 months)
         Birth Certificate
         Social History/SACWIS Integrated Assessment Report (INITIAL)
         Social History/SACWIS Integrated Assessment Report (CURRENT).
         SACWIS Client Service Plan/CFS 497 Service Plan – most recent only-showing SG as goal
         Temporary Custody Order
         Adjudicatory Order
         Dispositional Order
         Child Specific Section – Professional documentation –(eg: on pre-existing conditions.
         Medical, dental, school, psychological report(s).
         Home study including back up plan
         Backup Caregiver Checklist - including forms CFS 604, CFS 718, CANTS 48,- if required.

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Subsidy Packet after Court Transfer of Guardian:
         Appointing Order
         Vacating Order
         CFS 906 Placement/Payment – SGH on date of court transfer
                                      (0373 relative, 0374 non-relative)
         CFS 1420 Case Review Form – Permanency Goal of 26 GRDN
         CFS 1425 Change of Status – Transfer (do not close case)
         CFS 1425L Legal History – Legal Status = NO, Guardian = SG
         Close Juvenile Court Case before transfer to Post Adoption Unit
         Notify ACR Reviewers to cancel subsequent reviews
         Attach CM 07 screen (Cook Co. only)




Agency

Supervisor’s Printed Name

Supervisor’s Signature                                                     Date:

Phone number: _________________________________________




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