DATE (Enter Date Mailed Or Delivered.)

DATE (Enter date mailed or delivered.)

NAME / VIA: Regular Mail / Certified Mail Receipt No.
STREET ADDRESS / Hand Delivery
CITY, STATE ZIP / Other (PLEASE SPECIFY)

Dear NAME:

In accordance with the Department of Children’s Services (DCS) Policy 14.10, you are hereby notified that a Child Protective Services (CPS) investigation has identified you as a substantiated perpetrator of child neglect or child abuse involving (INSERT CHILD(REN)’S NAME(S).

The Department has been notified that:

You have been arrested and charged with a criminal offense stemming from the same allegations as the child abuse or neglect classification being reviewed.
You have been substantiated on criminal charges stemming from the same allegations as the child abuse or neglect classification being reviewed.
You have been named in a civil, judicial proceeding or there is a civil proceeding, stemming from the same allegations as the child abuse or neglect classification being reviewed. (Name the proceeding; Juvenile Court, Chancery Court, etc.)
You have been named in an administrative proceeding stemming from the same allegations as the child abuse or neglect classification being reviewed.

You may have the right to a Formal File Review by DCS after the above-mentioned court activity is resolved. The purpose of a Formal File Review is to evaluate whether there is enough evidence to support the substantiation.

A Formal File Review can be requested after the above-mentioned court activity has been resolved.

However, should you plead guilty or the court/administrative proceeding finds that you did commit child neglect or child abuse (or knowingly allowed child neglect or child abuse to be committed), there will be no further review.

To request a Formal File Review (after the above-mentioned court activity has been resolved), complete the attached form and return it to the address listed on the form. Your Formal File Review request will be accepted if you so request within thirty (30) business days of the date a final court order is issued (see pending court action checked above). This final court order needs to accompany the attached form.

If you fail to request the review within thirty (30) business days of the date of a final court order, you will waive your right to a Formal File Review unless good cause can be shown for your delay. Good cause may be shown by documented proof of a serious illness or disabling condition that substantially prevents the return of your request within a thirty (30) business day time limit.

Once requested, the Department will, within ten (10) business days of receipt of your request, send written notice to you of your obligations in the Formal File Review process.

If you have any further questions, contact us at the Enter Name of County County DCS Office at (Enter phone number), Monday through Friday from 8:00 a.m. to 4:30 p.m.

Sincerely,

(NAME)

Case Manager

ENCLOSURE

------FOR USE ONLY WHEN LETTER IS HAND DELIVERED------

My signature below certifies receipt (by hand delivery) of the above notification. My signature does not signify my agreement in any form with the classification made by the Department of Children’s Services.

______

INSERT NAMEDATE

______

WITNESSDATE

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Rev 06/15