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If you have created a username and password for the TDHS Relief Portals (Emergency Cash Assistance, D-SNAP, Pandemic Child Care Assistance and/or P-EBT Parent Portal) you may use your existing login information to access services through the new Customer Portal (https://OneDHS. 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Attach all necessary documentation (i.e. Information for youth, parents and caregivers, CFS 1425-L Legal History Maintenance Form, CFS 1427-A-SA Legal Screening Checklist - Simplified Screening for Adoption, CFS 1427-A-SG Legal Screening Checklist SG-KinGap, CFS 1427-A-T Legal Screening Checklist - Termination of Parental Rights-Adoption, CFS 1427-SA Legal Screening Form Simplified Adoption, CFS 1427-SG Legal Screening Form SG-KinGap, CFS 1427-T Legal Screening Form Termination of Parent Rights, CFS 1441-B Safety Plan Termination Agreement, CFS 1441-C Safety Plan Team Assessment Meeting Form, CFS 1441-D Safety Plan Rights & Responsibilities for Parents and Guardians, CFS 1441-E Safety Plan Rights & Responsibilities for Responsible Adult Caregiver & Safety Plan Participants, CFS 1441-F Safety Plan Responsibilities for Child Protection Specialists and Caseworkers, CFS 1443 Permanency Commitment By Foster Parent / Relative Caregiver, CFS 1448 Extended Family Support Program Referral DCP-Intact, CFS 1448-A EFSP Referral Received Confirmation, CFS 1448-D EFSP Case Withdrawn Billing Form, CFS 1448-F EFSP Tracking Form for Request for CANTS and LEADS Information, CFS 1448-G EFSP Closing Report and CFS 1448-PA, EFSP Post Adoption Referral Form, CFS 1448-PA EFSP Post Adoption Referral Form, CFS 1452-1 Clinical Intervention For Placement Preservation (CIPP) Meeting Referral Form, CFS 1452-2 Clinical Intervention For Placement Preservation (CIPP) Action Plan, CFS 1452-3 Referral Packet Documentation Checklist, CFS 1452-4 Documented Efforts to Prevent Emergency Shelter Placement, CFS 1452-5 Documented Efforts to Transition Children and Youth From Shelter Placement, CFS 1800-A-1 Adoption Assistance Eligibility for Children Not Under the Legal Responsibility of Illinois Department of Children and Family Services, CFS 1800-A-A Adoption Assistance Eligibility Determination, CFS 1800-A-G Subsidized Guardianship Eligibility Determination, CFS 1800-B-A Adoption Assistance Application, CFS 1800-B-G Subsidized Guardianship Application, CFS 1800-C-A Interim Adoption Assistance Agreement, CFS 1800-C-A Adoption Assistance Agreement, CFS 1800-C-G Subsidized Guardianship Agreement, CFS 1800-C-G Interim Subsidized Guardianship Agreement, CFS 1800-F Amendment to Agreement for Assistance, CFS 1800-H Termination of Adoption/Guardianship Assistance, CFS 1800-I Follow-up Letter to telephone call re change in child's needs, CFS 1800-J Letter acknowledging receipt of written request, CFS 1800-K Post Adoption/Guardianship Services Review Committee Request for Additional Services, CFS 1800-L Decision Letter Re Change in Child's Needs Circumstance, CFS 1800-M Notice of Intent to Discontinue Subsidy Payments on 18TH Birthday, CFS 1800-M-1 Notice of Intent to Discontinue Subsidy Payments on 18th Birthday (Fillable), CFS 1800-M-1a Notice for Documentation to Continue Subsidy Payments Until Age 19 or 21 (Fillable), CFS 1800-M-2 Final Notice of Intent to Discontinue Subsidy Payments (Fillable), CFS 1800-N Dissolved Subsidized Adoption/Guardianship Checklist, CFS 1800-O Termination of Interim Adoption and Guardianship Assistance, CFS 1800-P Adoption/Guardianship Verification of Ongoing Monthly Subsidy Payment Amount, CFS 1800-PAGS Post Adoption and Guardianship Services Acknowledgement, CFS 1800-R Status of continued Medicaid eligibility, CFS 1800-S Approved Subsidy Maintenance Form, CFS 1800-SC Post Permanency Sibling Contact Agreement, CFS 1800-SC Post Permanency Sibling Contact Agreement (with lines to complete by hand), CFS 1800-T-A Adoption Assistance Case Record Checklist, CFS 1800-T-G Subsidized Guardianship (KINGAP) Case Record Checklist, CFS 1901 Emergency Shelter Approval Form (Fillable), CFS 2000 Day Care Service Eligibility Application, CFS 2000 Instructions for Day Care Service Eligibility Application, CFS 2000-A Intact Family Services Case - IDCFS-IDHS Child Care Services Referral Form, CFS 2000-R Day Care Services - Eligibility Redetermination Application, CFS 2003 On-Site Visit License-Exempt and Unlicensed DC Provider, CFS 2018 Inter-Ethnic Placement Act Assessment Form, CFS 2023 Special Needs Allowance Utilization Form, CFS 2025 Home Safety Checklist for Intact and Permanency Workers, CFS 2026 Home Safety Checklist For Parents and Caregivers, CFS 2027 Home Safety Checklist for Child Protection Specialists, CFS 2032 2 Your Future, Your Health - Power of Attorney for Health Care, CFS 2032-3 Certification of Receipt of Information & Education Regarding Health Care Options, CFS 2032-5 Countdown to 21 - Quarterly and Annual Data Report, CFS 2032-7 Re-Entry Alternative Contract Approval, CFS 2034 Social Media/Mobile Technology for Youth in Care, CFS 2040-1 Request for IFS Tier 2 Designation (Fillable), CFS 2040-2 Intact Family Service Extension Request, CFS 2040-WR Intact Family Services Weekly Report (Excel File), CFS 2050-Part A Request for Video Contact with a Parent in IDOC (Fillable), CFS 2050-Part B IDOC Video Contact Parental Participation Agreement (Fillable). We, the Village seeks to ensure all Illinois children can receive the child care and early education they need, and parents want, from birth to kindergarten. Parent and Child Care Provider Experiences During COVID-19, Individual Professional Development Funds, Community Parenting Support Saturation Program, Community Systems Statewide Supports (CS3), Early Childhood Mental Health Consultants, Maria Whelan Leadership Institute Early Childhood Emerging Leaders Fellowship, formulario de acuerdo por correo electrnico. Child Care Application - To apply for child care assistance. 1-800-843-6154 Below are links to some commonly-used forms. The signNow extension was developed to help busy people like you to reduce the stress of putting your signature on papers. IAFC specializes in supports and resources for child care and early learning programs. 160 0 obj <> endobj xref Copyright 2023 Illinois Action for Children. Yes NoMy information has changed due to:Gave Birth/Adding Family MemberAdd Family Member (needs child care)Add Family Member (does not need child care)Leave of Absence (attach Doctor's & employer letter)MedicalMaternityAdoptionStart Date: End Date:Start Date:End Date:Add Family Member (needs child care)Add Family Member (does not need child care)Death (Complete Section 1)Delete Family member (other parent/adult)Delete Child from CaseChild over 13 Years of Age (no longer needs child care)Got Married (complete Other Parent/Adult sections)New Name:Family Size changed from:Got Divorced (complete Other Parent/Adult sections)New Name:Family Size Changed from:Separated (complete Other Parent/Adult sections)New Name:Family Size changed from:Widowed (complete other Parent/Adult sections)New Name:Family Size changed from:New Phone:Moved:Old Phone Number:New Address:Old Address:totototoProvider #2:Address:Provider ID#:Co-pay collected from this Prov.? Our experienced Parent Consultants help make finding desirable child care less stressful. Suite 1700, 0000003298 00000 n The whole procedure can take a few moments. Comments and Help with il444 3455e. After that, your illinois action for child care application is ready. "/y,gBy}/2B,iBDnt7&$D 6}F6 mogK*zw2=0/>ht30wrU}R]b-6Ly\HZ'[W55*-E9=MhS?tYU5uyjRjdM7h"Z4@]irm"yU (F3obsV-z6)|.lg J;U;j:q#!M*t|$GM_@yK. Due to its cross-platform nature, signNow is compatible with any gadget and any operating system. Find a child care provider who will be willing to accept the child care assistance funding. Once the child care provider has received your case file they will be able to complete an Eligibility Review for Child Care Assistance and an Application for Child Care Assistance. At the main menu, select the option for the Child Care Assistance Program and an agent can send you the form you need. These are all the verified links of "tricare east provider portal" And now you can access easily and we also have provided the other helpful links for. signNow makes signing easier and more convenient since it provides users with a range of additional features like Invite to Sign, Merge Documents, Add Fields, etc. Copyright 2022 IL Department of Central Management Services, Protecting Children from Domestic Violence, Heart Gallery of Illinois Children in Need of a Forever Family, Relatives Raising Children/Extended Family Support, Promoting Independence and Self-Sufficiency, Learn About Becoming a Foster/Adoptive Parent, Division of Diversity, Equity and Inclusion (DEI), Family First Prevention Services Act (FFPSA), (right click and select "Save Target as" or "Save Link as" to download to your pc), Action Transmittals and Other Emergency Policies in response to COVID-19, CANTS 2A Suspected Abuse Injury Notesheet - Infant, CANTS 2B Suspected Abuse Injury Notesheet - Child, CANTS 4 Written Confirmation of Suspected Child Abuse/Neglect Report: Medical Professionals, CANTS 5 Written Confirmation of Suspected Child Abuse/Neglect Report: Mandated Reporters, CANTS 8 Notification of a Report of Suspected Child Abuse and/ or Neglect, CANTS 8-Polish ZGOSZENIE DONIESIENIA O PODEJRZENIU O ZNCANIU SI / ZANIEDBYWANIU DZIECI, CANTS 9 Notification of Intent to Indicate Child Care Worker for Report of Child Abuse and/or Neglect, CANTS 10 Notification of Intent to Indicate Child Care Worker for Report of Child Abuse and/or Neglect Questions and Answers, CANTS 11 Notification of Decision in an Employment Related Report of Child Abuse and/or Neglect, CANTS 22 Acknowledgment of Mandated Reporter Status Form, CANTS 22-A Acknowledgment of Mandated Reporter Status (Clergy) Form, CANTS 22-B Acknowledgement of Mandated Reporter Status, CANTS 23 Acknowledgement of Non-Disclosure of Information, CANTS 65-A Referral Form for Medical Evaluation of a Physical Injury to a Child, CANTS_65-B Evaluation of Medical Neglect of a Child, CFS 119-A Unusual Incident Disposition Form, CFS 123 Electronic Mail Communication and Distribution Certificate of Understanding, CFS 151-B, Notice of Change of Placement Form, CFS 151-E Summary of Clinical Placement Review, CFS 151-H Notice to Relatives of Child Entering Substitute Care, CFS 151-J Grandparent Visitation with Youth in Care, CFS 152 Disability Related Services Report, CFS 152A Children's Account Unit Assessment Form, CFS 152B Children's Account Unit Disbursement Request Form, CFS 230 ACR Feedback Response and Action Plan (FRAP)for Critical Issues, CFS 231 ACR Critical Feedback Communication Notice, CFS 250 Guiding the Caregiver Through Self-Assessment for Reunification Support, CFS 250-A Discussion Questions to Consider with Caregivers Before Self-Assessment, CFS 301-80 Waiver of Exception to Placement Restriction for Unlicensed Homes, CFS 307 Indian Child Welfare Advocacy Program Intake Form, CFS 356 ACR Satisfaction Survey (fillable), CFS 370-1 Norman Class Certification For Reunification or Intact Family Cases, CFS 370-5 Norman Cash Assistance or Housing Advocacy Referral, CFS 370-5YHAP Youth Housing Assistance Program Request for Cash Assistance and/or Housing Advocacy, CFS 374 Transition Funding Application and Disbursement Plan, CFS 375-1 ILO TLP Request for Extension of Services (Fillable), CFS 375-1 ILO TLP Request for Extension of Services (With lines to complete by hand), CFS 375-2 ILO TLP Quarterly Transition Discharge Launch Plan (password protected Word document), CFS 387 Adoption and Safe Families Act (ASFA) Survey for ACR - Fillable, CFS 399-6 Specialty Services Case Consultation Referral Form, CFS 402-1 Waiver Of Licensing Standards For Foster Family Homes - Instructions, CFS 402-1 Waiver Of Licensing Standards For Foster Family Homes, CFS 403 Final And Irrevocable Consent To Adoption By A Specified Person Or Persons-DCFS Case, CFS 403 Polish OSTATECZNA I NIEODWOALNA ZGODA NA ADOPCJ PRZEZ WSKAZAN OSOB LUB OSOBY: SPRAWA PROWADZONA PRZEZ DEPARTAMENT DS. 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