(A)The public children services agency (PCSA) shall establish a state adoption 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. 10/2001).

(2)JFS 01613 "Application for State Adoption Subsidy" (rev. 7/2004).

(3) Copy of the Title IV-E adoption assistance denial to include the JFS 01451 "Title IV-E Adoption Assistance Application" (rev. 10/2006), JFS 01451A "Title IV-E Adoption Assistance Eligibility Determination" (rev. 4/2010) and the JFS 07334 "Notice of Denial of Your Application" (rev. 9/2011).

(3) Documentation noting the adoptive parent(s) application and denial for Title IV-E adoption assistance eligibility.

(4)Documentation of the adoptive child's special needs for the purposes of the state adoption subsidy program.

(5)Verification of financial needfamily's annual gross income at initial application and redeterminations.

(6)JFS 01615"Approval for State Adoption Subsidy" "State Adoption Maintenance Subsidy Agreement" (rev. 7/20044/2014).

(7) JFS 01614 "Redetermination or Amendment of a State Adoption Maintenance Subsidy" (4/2014).

(7)(8) JFS 01618 "Redetermination/Amendment of State Adoption Special Services Subsidy" (rev. 7/2004), as applicable.

(8)(9) 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. 10/2007)(rev. 9/2011), asif applicable.

(9)(10) JFS 01449 "Determination of Special Needs for Medical, Mental Health or Rehabilitative Care" (rev. 7/2004) to determine whether the child has or does not have special needs for medical, mental health, or rehabilitative care.

(10)(11) Copy of the final decree of adoption.

(11)(12) Case notes and dictations concerning the activities of the state adoption subsidy case.

(12)(13) 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.

(13)(14) Child study inventory, for PCPA applications.

(14)(15) JFS 01616 "Social and Medical History" (rev. 6/2006)(rev. 6/2009).

(15)(16) JFS 01673 "Assessment for Child Placement (Homestudy)" (rev. 8/2005).(rev. 6/2011) or JFS 01692 "Application for Adoption of a Foster Child," (rev. 6/2009).

Effective: