Permanency Plan Adoption and Safe Families Act Addendum

PERMANENCY PLAN ADOPTION AND SAFE FAMILIES ACT ADDENDUM

Permanency Plan ASFA AddendumPage 1 of 1

CFS-???? (??/????)

Date / Name - Agency
[TM1] / [TM2]
Name - Child (Last, First, MI)
[TM3] / Birthdate - Child
[TM4]
Name - Mother (Last, First, MI) / Telephone Number - Mother (Home) / Telephone Number - Mother (Work)
[TM5] / [TM6] / [TM7]
Address - Mother (Street, City, State, Zip Code)
[TM8]
Name - Father (Last, First, MI) / Telephone Number - Father (Home) / Telephone Number - Father (Work)
[TM9] / [TM10] / [TM11]
Address - Father (Street, City, State, Zip Code)
[TM12]
Reason why Termination of Parental Rights (TPR) is not being pursued at 15 of 22 months.
[TM13] / Child is placed with a fit and willing relative.

[TM14]

[TM15] / Compelling reason(s) why TPR is not in the child’s best interest.

[TM16]

[TM17] / Reasonable efforts to safely return the child to his or her home have not been made.

[TM18]

[TM19] / Grounds for involuntary TPR do not exist.

[TM20]

[TM21]
Name - Worker
SIGNATURE - Worker / Date Signed
[TM22]
Name - Supervisor
SIGNATURE - Supervisor / Date Signed

Permanency Plan ASFA AddendumPage 1 of 1

CFS-???? (??/????)

[TM1]This field is pre-filled. This field is not editable on the template. The data cannot be corrected.

[TM2]This field is user entered. This field is editable on the template. The data can be corrected on the template.

[TM3]This field is pre-filled. This field is not editable on the template. The data can be corrected as follows: update the child’s Person Management page.

[TM4]This field is pre-filled. This field is not editable on the template. The data can be corrected as follows: update the child’s Person Management page.

[TM5]This field is pre-filled. This field is not editable on the template. The data can be corrected as follows: update the child’s mother’s Person Management page. The child’s mother is identified on the Parent Info tab of the child’s Person Management page.

[TM6]This field is pre-filled. This field is not editable on the template. The data can be corrected as follows: update the Address tab of the child’s mother’s Person Management page.

[TM7]This field is pre-filled. This field is not editable on the template. The data can be corrected as follows: update the Address tab of the child’s mother’s Person Management page.

[TM8]This field is pre-filled. This field is not editable on the template. The data can be corrected as follows: update the Address tab of the child’s mother’s Person Management page.

[TM9]This field is pre-filled. This field is not editable on the template. The data can be corrected as follows: update the child’s father’s Person Management page. The child’s father is identified on the Parent Info tab of the child’s Person Management page.

[TM10]This field is pre-filled. This field is not editable on the template. The data can be corrected as follows: update the Address tab of the child’s father’s Person Management page.

[TM11]This field is pre-filled. This field is not editable on the template. The data can be corrected as follows: update the Address tab of the child’s father’s Person Management page.

[TM12]This field is pre-filled. This field is not editable on the template. The data can be corrected as follows: update the Address tab of the child’s father’s Person Management page.

[TM13]This field is pre-filled. This field is not editable on the template. The data can be corrected as follows: update the Permanency Plan – ASFA Exceptions page.

[TM14]This field is pre-filled. This field is not editable on the template. The data can be corrected as follows: update the Permanency Plan – ASFA Exceptions page.

[TM15]This field is pre-filled. This field is not editable on the template. The data can be corrected as follows: update the Permanency Plan – ASFA Exceptions page.

[TM16]This field is pre-filled. This field is not editable on the template. The data can be corrected as follows: update the Permanency Plan – ASFA Exceptions page.

[TM17]This field is pre-filled. This field is not editable on the template. The data can be corrected as follows: update the Permanency Plan – ASFA Exceptions page.

[TM18]This field is pre-filled. This field is not editable on the template. The data can be corrected as follows: update the Permanency Plan – ASFA Exceptions page.

[TM19]This field is pre-filled. This field is not editable on the template. The data can be corrected as follows: update the Permanency Plan – ASFA Exceptions page.

[TM20]This field is pre-filled. This field is not editable on the template. The data can be corrected as follows: update the Permanency Plan – ASFA Exceptions page.

[TM21]This field is pre-filled. This field is not editable on the template. The data can be corrected as follows: the worker’s supervisor can update the worker’s Person Management page.

[TM22]This field is pre-filled. This field is not editable on the template. The data can be corrected as follows: update the supervisor's Person Management page.