Legal Guardianship Agreement 04MP044E 001 State Funded Guardianship Assistance

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Legal Guardianship Agreement 04MP044E 001 State Funded Guardianship Assistance Powered By Docstoc
					                         *04MP044E-001*


             State Funded Guardianship Assistance Agreement
 Legal guardian(s) name                                                 KK number


         It is important to read this document in its entirety before signing.

The State offers limited state funded assist ance based upon defined eligib ility criteria to
persons who have assumed a pe rmanent legal guar dianship of a child or children in
OKDHS legal custody.

The purpose of the State F unded Guardianship Ass istance Agreement (Agreement) is
to set forth the mutual obligations between the State and the legal guardian payees of
the guardianship ass istance. T his Agreement is a legally binding cont ract between
OKDHS, Children and Family Services Div ision (CFSD) Permanency Planning Section,
and [name and address of legal guardian(s)]                               , hereinafter
referred to as legal guardian(s).
This Agreement is in accordanc e with applic able state law and may remain in effect
regardless of the legal guardian(s)' state of residence, provided:
    (1) state guardianship assistance funds are available;
    (2) the case remains eligible to receive state funded guardianship assistance; and
    (3) the guardian(s) maintains compliance with this Agreement.
This Agreement is for the benef it of the child(ren), legal guardian(s), and State and is
enforceable by any or all of them.

a. Legal guardian(s) agrees to:
    1.   provide O KDHS wit h a Decree of Guar dianship, L etters of Gu ardianship, an
         Order A ppointing G uardian o r o ther sa tisfactory evidence, as determined b y
         OKDHS, that a legal guardianship has been established betwe en the child and
         applicant(s) for state funded guardianship assistance;
    2.   complete OKDHS F orm 04AN044E, St ate Funded Guardians hip Ass istance
         Annual Review, informing OKDHS of chil d's current educational enrollment with
         letter of verification of attendance fr om authorized sc hool personnel and any
         changes in family circumstances. Form        04AN044E is mailed to the family
         annually and must be returned to OKDHS         within 30 days of the date of the
         annual review request;




Form 04MP044E issued 12-17-2009 may continue on next page, page 1 of 4
   3.   immediately notify, in writing, OKDHS, Permanency Planning Section, P.O. Box
        25352, Oklahoma City, OK 73125, if ANY of the following occur:
        A. change in family's address;
        B. change in t he family or household com position, including but not limited to
             divorce, marriage dissolution, or legal separation of legal guardian(s), or if a
             person moves into the guardian's residence;
        C. child enters military service;
        D. marriage of child;
        E. name change of child;
        F. child is no longer in the home due to movement to p sychiatric, residential,
             therapeutic or foster family care, or other living arrangement;
        G. death of child;
        H. legal guardian(s) is no longer financ ially supporting the ch ild or is no longer
             legally responsible to support the child; and
        I. legal guar dian has requested the c          ourt to modify or terminate the
             guardianship; and
   4.   reimburse OKDHS for any payment         s made after the child(ren) becomes
        ineligible f or State f unded guardianship assistance, or for any other
        overpayment received from OKDHS on beh alf of the c hild(ren), including, but
        not limited to, overpayment of foster care payments.

b. OKDHS agrees to:
   1.   provide state funded guardianship assistance as follows:
                                                  Date              State funded
                 Child(ren)                      of birth      guardianship assistance
                                                              $
                                                              $
                                                              $
                                                              $
                                                              $
                                                              $
                                                              $
                                                              $
   2.   continue s tate funded guardianship assist ance if the legal guardian(s) and
        child(ren) move to another state provided funds re main available, and the
        child(ren) remains eligible to receive state funded guardianship assistance.

c. OKDHS and legal guardian(s) mutually acknowledge and agree:
   1.   The state funded guardianship assist ance amount will change in cases of an
        across-the-board reduction or increase in OKDHS foster care maintenance rates.
   2.   Any modification to this Agree     ment will have prospective effect and not
        retroactive effect.


Form 04MP044E issued 12-17-2009 may continue on next page, page 2 of 4
   3.   This Agreement shall terminate if one of the conditions in A through F is met.
        A. The child has attained the age of 18 y ears, except the child may continue to
           receive state funded guardianship until the day of the child's 19th birthday if
           the child c ontinues to attend high sc hool or pursues General Educational
           Development (GED).
        B. The legal guardian(s) fails to submi t, not later than 60 days prior to the child
           reaching age 18, a request for state       funded guardianship ass istance to
           continue beyond age 18. The reques           t for state funded guardianship
           assistance to continue beyond age 18 includes:
                  • a statement from authorized school personnel documenting high
                     school attendance and anticipated date of graduation; or
                  • a statement from authorized sc hool pers onnel doc umenting the
                     child is pursuing GED.
        C. OKDHS determines that the legal           guardian(s) is no longer legally
           responsible for support of the child(r en) or no longer providing financial
           support to the child(ren).
        D. OKDHS determines that the legal guar dian(s) is no longer providing for the
           care of the child(ren).
        E. All of the child's legal guardian(s) are deceased.
        F. OKDHS determines the legal guardian( s) is not in compliance with one or
           more terms of this Agreement.
   4.   In the event the legal guardians are co-guardians to the child a nd obtain a
        divorce, marriage dis solution, legal sepa ration, or init iate such proceedings,
        OKDHS may change the payee of the Stat e funded guardianship assistance to
        the guardian who retains phys ical custody of the c hild when that fact is
        established by a court order from the cour t of jurisdiction over the guardianship
        or companion deprived proceeding, if any, or by other satisfactory evidence as
        determined by OKDHS. In the event t       here is a dis pute between the legal
        guardians as to whom State funded gu ardianship assistance shall be m ade,
        OKDHS may withhold payment under this Agreem ent until the dispute is
        resolved, at which time OKDHS shall re lease all withheld funds to the payee
        who retains physical custody of the child upon that fact being independently
        verified by OKDHS or upon receipt of      a written agreement signed by b oth
        guardians under penalty of perjury.
   5.   Due to possible future reductions        in state appropriations, OKDHS cannot
        guarantee the continued availability of full funding for this Agreement. In the
        event funds to finance this Agreement bec ome unavailable, eith er in full or in
        part, due to reductions in appropriati         ons, OKDHS may terminate this
        Agreement or reduce the pay ments or other benefits upon notice in writing to
        the legal guardian(s). OKDHS shall be the final authority as to the availability of
        funds. The effective date of s       uch Ag reement termi nation or reduction i n
        payments or other benefits shall be spec         ified in the notice as the actual
        effective date of the state funding        reduction. State Funded Guardians hip
        payments and other benefits are made to eligible families provided OKDHS has
        sufficient funds available for this purpose.


Form 04MP044E issued 12-17-2009 may continue on next page, page 3 of 4
     6.     OKDHS does not pr ovide information ab out legal guardians(s)' State funded
            guardianship assistance for purposes of income verification.
     7.     The effective date of this Agreement is            .
     8.     Form 04AN044E, State F unded Guardianship Ass istance Agreement, must be
            signed by the legal guardian(s) and OK DHS before guardians hip assistance
            may be paid to the legal guardian(s).

d. Foster care overpayment appeal.
     The legal guardian(s) does no t have the right to appeal the decision of OKDHS to
     terminate or modify State Funded Guardianship Ass istance. However, an appea l
     may be made in acc ordance with OKDHS adm inistrative rules if a guardianship
     assistance payment creates a foster ca re or Temporary Assistance for Needy
     Families (T ANF) over payment. Informati on regarding the appea l process may be
     requested from the CFSD Permanency Planning Section.

                    Unsworn declaration under penalty of perjury
I state under penalt y of perjury under the  laws of Oklahoma that the information
contained in the foregoing Agreement is true and correct to the best of my information
and belief.

Subscribed on this                            of
                            day                       month               year
at
                                              ,
          city                                        state


                   Legal guardian signature                   Social Security number


                   Legal guardian signature                   Social Security number

OKDHS use only:


                 OKDHS representative signature                    Date




Form 04MP044E issued 12-17-2009 may continue on next page, page 4 of 4

				
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