(A)The public children
services agency (PCSA) shall establish a state adoption maintenance
subsidy record for each child's application for a state adoption maintenance
subsidy (SAMS).
(B)The state adoption
maintenance subsidy record shall contain all information applicable to the adoption
maintenance subsidy including, but not limited to the following:
(1)JFS 01654 "Adoptive
Placement Agreement" (rev. 10/20012/2017).
(2)JFS 01613 "Application
for State Adoption Maintenance Subsidy" (rev.
7/2004 4/2019).
(3)Copy of the Title
IV-E adoption assistance denial to include the JFS 01451 "Title IV-E Adoption
Assistance Application" (rev. 10/2006 12/2015), JFS 01451A "Title
IV-E Adoption Assistance Eligibility Determination" (rev. 4/2010) JFS 01451-B "Title IV-E Adoption Assistance Annual Assurance
of Legal Responsibility, School Attendance and Eligibility for Continued Medicaid
Coverage" (rev. 12/2015) and the JFS 07334 "Notice of Denial of
Your Application for Assistance" (rev. 9/2011).
(4)Documentation of
the adoptive child's special needs.
(5)Verification of
family's annual gross income at initial application and redeterminations.
(6)JFS 01615 "Approval for State Adoption Maintenance Subsidy Agreement"
(rev. 4/20144/2019).
(7)JFS 01614 "Redetermination
or Amendment of a State Adoption Maintenance Subsidy" (4/2014 4/2019).
(8)JFS 01618 "Redetermination/Amendment
of State Adoption Special Services Subsidy" (rev. 7/2004), as applicable.
(9)(8) Any JFS 04065 "Prior Notice of the Right
to a State Hearing" (rev. 5/2001) or JFS 07334 "Notice
of Denial of Your Application for Assistance"(rev. 9/2011), if applicable.
(10)(9)JFS 01449 "Determination of Special
Needs for Medical, Mental Health or Rehabilitative Care" (rev. 7/20047/2016) to determine
whether the child has or does not have special needs for medical, mental health,
or rehabilitative care.
(11)(10)Copy of the final decree of adoption.
(12)(11)Case notes and dictations concerning the
activities of the state adoption maintenance subsidy
case.
(13)(12)Requests for and findings of any state
hearings or administrative appeals conducted pursuant to section 5101.35 of the
Revised Code and division 5101:6 of the Administrative Code.
(14)(13)Child study inventory, for PCPA applications.
(15)(14)JFS 01616 "Social and Medical History"
(rev. 6/2009).
(16)(15)JFS 01673 "Assessment for Child Placement
(Homestudy)"(rev. 6/2011 12/2014) or JFS 01692 "Application for Adoption of
a Foster Child, or Sibling
Group" (rev. 6/200912/2014).
Effective: 8/1/2019
Five Year Review (FYR) Dates: 4/10/2019 and 08/01/2024
Certification: CERTIFIED ELECTRONICALLY
Date: 06/17/2019
Promulgated Under: 119.03
Statutory Authority: 5153.16, 5153.163
Rule Amplifies: 5153.163, 5153.16
Prior Effective Dates: 10/02/1980, 07/01/1990, 05/01/2003, 07/01/2004,
05/01/2009, 05/29/2014