FCASPL 114 (JFS 01376)
Family, Children and Adult Services Procedure Letter No. 114
April 23, 2007
TO: All Family, Children and Adult Services Manual Holders
FROM: Helen E. Jones-Kelley, Director
SUBJECT: Revisions to Children Services Licensing Form JFS 01376 and Making JFS 01276 Obsolete

This letter transmits changes made to the JFS 01376 "Waiver Request for CRCs and Group Homes" and announces that the JFS 01276 "Waiver Request for Agency Rules" has been made obsolete.

Effective December 31, 2006 the JFS 01276 was made obsolete. The JFS 01376 has been revised to incorporate the information once collected on the JFS 01276. All agency waiver requests should be submitted using the revised JFS 01376.

The following is a brief explanation of each of the proposed changes to the JFS 01376 form:

  • The Facility Name section adds Agency name in addition to facility name.
  • The CRC or Group Home section adds the words "if applicable".
  • There is a new section to enter the specific rule number to be waived.
  • There is a new section to specify the timeframe of the waiver request.
LOCATIONREMOVE AND FILE AS OBSOLETEINSERT/REPLACE
FORMS JFS 01276 (Rev. 1/1991)
JFS 01376 (Rev. 1/1991) 		JFS 01376 (Rev. 12/2006)
PROCEDURE LETTERS FCASPL NO. 114