Adoptive Placement Agreement

WINDOW OVERVIEW:

The Adoption Placement Agreement is opened from the Action drop down menu on the Detail Placement window. It is used to document the financial responsibility of the adoptive parents.

FIELD DESCRIPTIONS:

Child's Name: This field displays the first name, middle initial, last name, and name extension of the child.

Financial Responsibility Group Box:

The adoptive parent(s) will ... (select one or more of the following)

• Assume full financial responsibility: Select this box if the parents are assuming full financial responsibility.
• Receive financial assistance from DHHS ...(select one or more of the following)
• $ per day maintenance: Select this box if the parent is to receive financial assistance from DHHS.
• Maintenance Amount: Enter the amount of maintenance assistance from DHHS.
• Medicaid coverage: Select this box if the child will receive Medicaid coverage from DHHS.
• Medical payment for the following: Enter the specifics of any other medical payments in the text area.
• Child care through Title 392 if eligible: Select if child care is provided through Title 392

Note: The Adoptive Placement Agreement correspondence will show the same information as what is shown on this window.

ACTION BUTTONS:

	Select the OK button to save the financial information.
	Select the Cancel button to close the window without saving any changes.
	Select the Help button to open the Help information for this window.

(11-2015)