Foster Care & Adoption Policy Manual – Attachments

Attachment 1 - Citizenship and Immigration

WYOMING DEPARTMENT OF FAMILY SERVICES	CHAPTER: Attachment 1
IV-E Foster Care Policy Manual	SUBJECT : Citizenship and Immigration
POLICY NUMBER: IV-E 10 - 001	EFFECTIVE DATE: 07/01/10

Determine if each applicant or recipient meets one of the citizenship/immigration eligibility factors in the table below to qualify for IV-E.

Citizen/Noncitizen Eligibility
	IV-E (ME)
U.S. Citizen or resident of American Samoa or Swains Island (noncitizen national)	Yes
Illegal Immigrants	**No
Immigrants eligible indefinitely:
Lawful permanent resident (LPR) immigrants	Eligible after 5 years* Need 40 qualifying quarters
U.S. military connection (veteran, active duty, spouse or unmarried dependent child)	Yes
Battered spouse, child, or parent or child of a battered person with a petition pending under 204(a)(1)(A) or (B) or 244(a)(3) of the INA	Yes
Lawfully in U.S. on 8/22/96 & age 65 or older	No
Qualified immigrant receiving blind or disability benefits, or under 18 years of age, regardless of date of entry	No
Canadian born Indians under 289 of the INA	Yes
Member of an Indian Tribe under 4(e) of Indian Self-Determination and Education Assistance Act	No
Hmong or Highland Laotian refugees (fought on behalf of U.S. during Vietnam conflict)	No
*DO NOT count any quarter after 12/31/96 when the immigrant received benefits from CC, FS, LIEAP, FaC/ME, PO, federally funded foster care, etc.
Qualified immigrants eligible for 5 years (PO), 7 years (FaC/KC/ME), indefinitely (CC), and (FS) eligible for 7 years under PRWORA or indefinitely after 5 years in the US from date of entry of granting of status.
Paroled under 212(d)(5) of the INA for at least 1 year.	Eligible for one year
Refugee under 207 of the INA from date of entry into U.S.	Yes
Granted conditional entry under Section 203(a)(7) of the INA as in effect before April 1, 1980.	Yes
Cubans and Haitians under 501(e) of the Refugee Education Assistance Act of 1980 from date of entry or granting of status	Yes
Asylees from date granted asylum under 208 of the INA	Yes
Deportation is being withheld under 243(h) as in effect before 4/1/97, or 241(b)(3) of the INA from date of entry or granting of status	Yes
Amerasians under 584 of Foreign Operations, Export Financing and Related Program Appropriations Act from date of entry or granting of status	Yes
**Immigrants not eligible above may be eligible for medical assistance under Emergency Services for Aliens.

Attachment 2 - Verification Evidence

WYOMING DEPARTMENT OF FAMILY SERVICES	CHAPTER: Attachment 2
IV-E Foster Care Policy Manual	SUBJECT : Verification Evidence
POLICY NUMBER: IV-E 11-001	EFFECTIVE DATE: 07/01/11

FACTOR	PRIMARY EVIDENCE	SECONDARY EVIDENCE
AGE	Birth Certificate Adoption papers or records Church records Baptismal certificate Vital statistics records United States passport Family Bible records Indian census records Social Security records Military records School records Census records Driver’s license Court support order Juvenile court records Child welfare records	None
ASSETS: Accept client statement unless there is contrary information from community or DFS files
Bank accounts, CD’s, bonds, stocks, mutual funds	Bank officials Savings bonds Certificates of deposit Bank statements Viewing certificates, bonds or notes Notarized statement of contents	None
Bona fide effort to sell	Statement from realtor Signed realtor’s agreement to sell property Newspaper clipping Pamphlet of listings Other advertisement	None
Life insurance	Viewing the policy Insurance agent Insurance company Lodge or fraternal organization Union VA Employer Funeral director	None
Promissory note	Viewing notes Statement from bank officials	None
Other personal property, antiques, art work,	Sales receipts/ proof of purchase or sale Catalog Existing insurance appraisal Divorce decree Local merchant Statement from two knowledgeable sources in the community	None
Real property	Statement from county assessor or county clerk where property is located Deed/contract for mortgage Proof of sale Divorce decree	None
Vehicles - Ownership	Registration Title RIS interface Statement from DMV Proof of purchase or sale	None
Vehicles - Value	Edmunds Automobile Valuation Internet site (trade in value)	Appraisal from licensed dealer Payment book Statement from two knowledge- able sources in the community
CHILD SUPPORT
Assigned	Assignment of support, SS 501 A Report of non-custodial parent, DFS 543 *Note: For verification of received child support payments, see Income, Unearned, Support*	None
CITIZENSHIP/IMMIGRATION
By birth or naturalization (Includes persons born in D.C., Puerto Rico, Guam, U.S. Virgin Islands, Northern Mariana Is- lands, American Samoa or Swains Island) All documents must be either originals or copies certified by the issuing agency.	Naturalization papers (DHS forms N-550 or N-570) U. S. Passport Certificate of U.S. Citizenship (DHS forms N-560 or N-561) U.S. Birth certificate Cross match with State Vital Records Certification of Report of Birth (DS-1350) Report of Birth Abroad of a U.S. Citizen (FORM FS-240) U.S. Citizen ID card (Form I-197) An American Indian Care (I-872) Final Adoption decree showing the child’s name and U.S. place of birth Evidence of U.S. Civil Service employment before June 1, 1976 U.S. Military Record showing a U.S. place of birth	Hospital record of birth (not a souvenir type birth certificate) or extract of hospital record on hospital letterhead created at time of birth Life, Health or other insurance record showing a U.S. place of birth Federal or State census records Documents showing a U.S. place of birth prior to application for Medicaid (U.S. State Vital Stats notification of birth registration; An amended U.S. birth record Statement signed by the physician or midwife who attended the birth; Institutional admission papers from a nursing facility, skilled facility or other institution) Medical (clinical, doctor or hospital) record that indicates a U.S. place of birth (Excludes an immunization record) Written Affidavit (must be at least 2 affidavits from 2 individuals with at least one of the individuals not related to the applicant/recipient and cannot be the applicant/recipient; persons making the affidavit must be able to prove their own citizenship and identity; explain why documentary evidence does not exist; signed under penalty of perjury. Call State office if further assistance is needed to determine U.S. citizenship
By permanent residence	Alien registration card, I-151 or I-551 Re-entry permit	None
Parolee, Asylee, Refugee, Deportation Withheld	INS records (see prior section for INS address) I-94 marked refugee conditional entry or paroled Correspondence stating indefinite or voluntary departure, indefinite stay deportation or not under direct order of deportation I-220B for alien under INS order of supervision I-210 and/or letter for aliens granted deferred action status SDX or TPQY	None
Victims of trafficking	Certified letter for the Adult(s) from HHS, Office of Refugee Resettlement Similar uncertified letter for a child(ren)	None
CITIZENSHIP/ALIENAGE Continued
Canadian Indians	Unexpired Form I-551 with code S13 Unexpired temporary I-551 stamp on a Canadian passport Form I-94 with the code S13	Letter or other tribal document certifying at least 50% Indian blood; and Birth certificate or other satisfactory evidence of birth in Canada
Legal alien victim of domestic violence	Any official documentation of an approval or a petition pending setting the domestic violence status
Qualifying quarters	Verification from SSA TPQY interface on EPICS Wage information not covered by SSA match	None
DEDUCTIBLE EXPENSES
Dependent care	Statement of provider showing actual or prospective amount Actual bills/receipts from provider	None
Legally obligated CS	Court order Divorce or separation decree	None
Self-employment (actual expenses)	Business ledgers Income tax records	None
Shelter	Rent/mortgage receipts Landlord statement Lease agreement/ rental verification form	None
DEPRIVATION
Abandonment	Law enforcement records Court records	None
Continued Absence (Require two pieces of secondary evidence)	Deprivation Statement form SS 615	City directory Correctional institution records Court records Employment records Driver's license Health insurance card Law enforcement officials Lease agreement Letter with address correction requested Motor vehicle registration Post office Probation office records Records which show address different from foster care home/facility Rent receipt from non- relative landlord School records Signed statement from minister or other knowledgeable non-relative Statement from landlord of non-custodial parent or recipient Telephone directory Unemployment compensation records Union records
Death	Death certificate Vital statistics record Widow's or survivor's benefits VA or military service records Hospital records Funeral director's statement Indian census records Newspaper death notice	Institutional records Insurance company records Lodge, club or fraternal Memorial card
DEPRIVATION Continued
Two-parent incapacity claimed	DFS 110 Statement with information required on DFS 110	None
Disability	SSI or RSDI benefits for disability	None
Fleeing for personal safety or safety of child(ren), domestic violence	Court record Medical record Criminal record Law enforcement record Psychological record Child protection record Social service record Domestic violence agency record	None
Unemployed Parent (two-parent family)	UIB (unemployment insurance benefits interface) Employer’s statement Union records Lay-off slip Client statement	None
Principal Wage Earner	Dept of Employment interface Tax forms Wage stubs Employer’s statement Client statement	None
EDUCATION	Degree Diploma Transcript Signed statement from school Class schedule Grade report	None
EMANCIPATION	Marriage certificate Divorce decree Birth certificate Military papers Decree of emancipation
GOOD CAUSE
Child support claim	Medical records Written statement of mental health professional Written statement of person other than applicant/recipient Law enforcement records Court or legal records Written statement of child protection or social service personnel	None
IDENTITY	Driver's license with a photo School ID care with a photo ID card issued by Federal, State or local government with same information as on a driver’s license Military service records or ID’s Native American Tribal document U.S. Coast Guard Merchant Mariner card. U.S. Passport Immigration documents Cross match with a Federal or State governmental, public assistance, law enforcement or corrections agency’s data system to establish ID if the agency established and certifies true ID of the individuals	School records Report cards Child care or pre-school records An affidavit is only acceptable if it is signed under penalty of perjury by a parent or guardian stating the date and place of birth of the child and cannot be used if an affidavit for citizenship was provided. Record of child’s membership in a youth organization Baby’s hospital wrist band Newspaper announcement/articles Photo of child with the affidavit/statement attesting to the child’s identity signed by caseworker
INCOME: Accept client statement unless information to the contrary is known within the community or DFS
Wages and in-kind wages	Wage stubs Employer's statement or DFS 106 ES01 BDE (earned income BENDEX)	None
Self-employment	Business ledgers BDS (self-employment BENDEX) Income tax records	None
Unearned income	Award notice Official correspondence Recent check BDX (BENDEX) printout/interface SSA form 1610 SDX printout/ interface UIB (unemployment insurance benefits interface) Railroad unemployment benefits Third party query (TPQY) BDP (pension BENDEX) SRT (State retirement interface) UFO (IRS interface) Collateral contact with appropriate agency	None
Contributions	Statement from source of payment Copy of check Official correspondence DFS 105 Contribution Statement	None
Grants, scholarships	DFS 111 Financial Information Award notice Official printout/ correspondence	None
Support payments, re- retained or excess child support	Information from child support authority Clerk of Court in locality of court order Canceled checks from non-custodial parent Divorce or separation decree Statement from source of payment Court order/records Support agreement Income tax returns Employer’s record of attached wages Official correspondence Screen print of CSCR screen	None
LIVING WITH A RELATIVE	Current school record showing address of child and responsible relative Court Order	Hospital, clinic, health department or physician Court support order Juvenile court record Child welfare record Statement of minister, priest or rabbi Signed statement from a non-relative Visually observing child in the home Non-relative landlord's statement
LOANS - BONA FIDE	Written agreement to repay the money within a specified time Evidence the loan was obtained from an individual or establishment engaged in the business of making loans	None
PARENT IN/OUT OF HOME
Primary caretaker	None	School records Signed statement of non-custodial parent Signed statement of minister or other knowledgeable non-relative
PERMANENCY HEARING	Court Order	None
PLACEMENT	SS 501 A form from caseworker IV-E facility/home certificate or license Court order	None
RELATIONSHIP
Child and relative same or different surname	Birth certificate(s) Adoption papers or official records Indian census records Marriage license Divorce decree Court Order	Hospital or clinic records of birth Church records of birth, parentage Vital statistics records Baptismal certificate or records
Paternity or putative paternal relative	Marriage certificate Birth certificate Paternity papers Court order Adoption papers Indian census records	U.S. passport Records of verification if father listed or paternal relative listed and relationship identified: Social Security records Hospital/Clinic/Health Department records Child welfare agency records Census Bureau records Income tax records Insurance policy School/juvenile court records Military/veterans records Wills/deeds/trusts, etc. Baptismal certificate Notarized statements from both parents
REMOVAL DATE	Court Order Voluntary Placement Agreement	None
RESIDENCE	Statement of applicant/recipient Landlord statement Employer’s statement Collateral contact Post Office records Tax office records Rent/mortgage receipts Utility bills Item of mail with assistance unit name, address and current postmark Driver’s license/ DMV records Voter registration High school diploma Rent receipts, landlord statement Utility bills Voter registration card Wages, employer's statement School records Statement from post office	None
SCHOOL ATTENDANCE/ STUDENT STATUS	Statement from/contact with school authorities DFS 111	Current report card Correspondence from school authorities Registration information Correspondence from scholarship source Signed statement from non-relative with knowledge of child's attendance
Moved from another state and not pre-registered	School authorities from other state	Child welfare record Statement of client Report card Signed statement of non relative
SSN	Social Security card Documents/ printouts from SSA SSA 1610 TPQY Military discharge form DD-214 BENDEX/SDX Letter from hospital staff person Previously validated within two years and the evidence is still available	None

Attachment 3 - Sample Court Orders

WYOMING DEPARTMENT OF FAMILY SERVICES	CHAPTER: Attachment 3
IV-E Foster Care Policy Manual	SUBJECT: Sample Court Orders
POLICY NUMBER: IV-E 10 - 001	EFFECTIVE DATE: 7/1/10

The following Court Orders are examples using language which meets the federal
requirements for initial removals and ongoing permanency. Refer to IV-E Policy Manual
Chapter 7 for specific policy on court orders and court order language.

Attachment 3a – Order for Shelter Care – Initial removal
On page 2 of this court order the first and third paragraph have the contrary to welfare language and reasonable efforts to maintain the child in the home. The second paragraph that states reasonable efforts are being made to reunite does not matter since the required language is in other paragraphs. This court order meets the language requirements.

Attachment 3b – Order on Initial Appearance and Shelter Care Hearing
On page 3 of this order in the top half items 1 and 2 have the correct language reasonable efforts to prevent removal and not in the best inters/contrary to the welfare. Item 4 names the placement and item 5 states DFS agrees with the placement showing DFS had input into the placement decision. This court order meets the language requirements.

Attachment 3c – Order Following Shelter Care Hearing – Initial removal
This court order does not meet the reasonable efforts for removal language. On page 2 in the second paragraph it does has the correct best interest language. The reasonable efforts language in this paragraph refers to reuniting the child with the family not the required prevent removal. If there is another court order within 60 days of the removal with the correct reasonable efforts language, the child could become IV-E eligible.

Attachment d – Order Upon Permanency Hearing—Permanency
This order has good language to establish the permanency goal and that reasonable efforts are being made to achieve the goal.

Attachment e – Order on Review Hearing – Permanency
Item 6 states a Permanency Goal has been established as documented in the case plan. This court order may be acceptable if we have a copy of the case plan and the plan establishes to goal and shows the reasonable efforts that have been or are being made to achieve the goal.

Attachment f – Order Upon Review Hearing – Permanency
This order states in item 2 that Guardianship is the permanency goal. However there is no statement that reasonable efforts are being made to achieve this goal. This court order will not meet the requirements for permanency language.

Attachment g – Reconvened 12 Month Review Hearing – Permanency
This court order is not acceptable for permanency language because there is no permanency goal stated and no reasonable efforts language to achieve a goal.

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