DCFS Caseworker Recommendation for Use of Child's Funds for Special Needs Instructions
This form contains 24 fields organized into 5 sections. Below is a complete list of every field, its type, and what information is expected.
| Field Name | Type | Description |
|---|---|---|
| Case Worker Telephone | ||
| Case Worker Telephone Area Code | Text |
Please enter the area code for the case worker's telephone number.
|
| Case Worker Telephone Number | Text |
Please enter the remaining digits of the case worker's telephone number.
|
| Child Identification | ||
| Text1 | Text | |
| Text2 | Text | |
| Current Placement | ||
| Placement Name | Text |
Please enter the name of the current placement location or individual.
|
| Placement Address | Text |
Please enter the street address of the current placement.
|
| Placement City, State, and Zip | Text |
Please enter the city, state, and zip code of the current placement.
|
| Explanation for Fund Use | ||
| Detailed Explanation | Text |
Provide a detailed explanation of the child's disability and the cause for requesting the use of these funds. Fill only if 'Special Needs Met by Child's Account - Yes' is 'Yes'.
Depends on:
Special Needs Met by Child's Account - Yes
|
| General | ||
| SGH | Checkbox |
Check this box if the permanency goal for the child is Subsidized Guardianship (SGH).
|
| Adoption | Checkbox |
Check this box if the permanency goal for the child is Adoption.
|
| Return Home | Checkbox |
Check this box if the permanency goal for the child is to Return Home.
|
| Independence | Checkbox |
Check this box if the permanency goal for the child is Independence.
|
| Guardianship Expected to End - Yes | Checkbox |
Check this box if DCFS guardianship for the child is expected to end within 30 days.
|
| Guardianship Expected to End - No | Checkbox |
Check this box if DCFS guardianship for the child is NOT expected to end within 30 days.
|
| Special Needs Met by Child's Account - Yes | Checkbox |
Check this box if the child has any special needs, currently or in the foreseeable future, that you believe could be met with allowable expenditures from the child's account.
|
| Special Needs Met by Child's Account - No | Checkbox |
Check this box if the child does NOT have special needs that you believe could be met with allowable expenditures from the child's account.
|
| Text12 | Text | |
| Text13 | Text | |
| Text14 | Text | |
| Text15 | Text | |
| Text16 | Text | |
| Text17 | Text | |
| Recommend Allocation for Special Needs - Yes | Checkbox |
Check this box if you recommend allocating funds from the child's account to provide services or purchase items to meet these special needs.
|
| Recommend Allocation for Special Needs - No | Checkbox |
Check this box if you do NOT recommend allocating funds from the child's account to provide services or purchase items to meet these special needs.
|