California Department of Social Services

Form KG 3 is the Kin-GAP Mutual Agreement for Nonminor Former Dependents. This form is used in the context of the Kinship Guardianship Assistance Payment (Kin-GAP) program. It outlines the mutual agreement between the nonminor former dependent and the relative caregiver regarding the terms and conditions of the Kin-GAP assistance. The form covers important aspects such as financial support, living arrangements, educational support, and other services provided to the nonminor former dependent under the Kin-GAP program.

The instructions accompanying Form ICPC-100B provide detailed guidance on completing the report known as "Interstate Compact Report On Child's Placement Status." This report is part of the Interstate Compact on the Placement of Children (ICPC) process and is used to provide updates and information on the placement status and well-being of a child who has been placed in another state under the ICPC. The instructions explain how to accurately fill out the form and what information should be included to ensure effective communication between the sending and receiving agencies.

Form IHSS-E-007 is a notice issued by the In-Home Supportive Services (IHSS) program to inform recipients about the expiration of their provider's exemption from workweek limits. It notifies the IHSS recipient that their assigned provider's authorization to work beyond the standard limitations will expire on a specific date. This form ensures that the recipient is aware of the upcoming change and can make any necessary arrangements or adjustments to their care plan in anticipation of the provider's expiration of the exemption from workweek limits.

Form IHSS-E-006 is a notice issued by the In-Home Supportive Services (IHSS) program to inform providers about the upcoming expiration of their exemption from workweek limits. It notifies the provider that their authorization to work beyond the standard limitations will expire on a specific date. This form ensures that the provider is aware of the impending change and can make necessary arrangements or adjustments to their work schedule in compliance with the upcoming expiration.

Form ICPC-100A is the actual request form for the Interstate Compact on the Placement of Children (ICPC). This form is used by individuals or entities involved in child welfare services to initiate the process of placing a child from one state into the care of an approved caregiver or institution in another state. It collects essential details about the child, the sending agency, the receiving agency, and the proposed placement, ensuring that all relevant information is provided to facilitate the necessary approvals and evaluations required under the ICPC.

Form IHSS-E-005 is a notice issued by the In-Home Supportive Services (IHSS) program to inform providers that they are ineligible to request an exemption from workweek limits for extraordinary circumstances. It notifies the provider that their request for flexibility in working hours due to exceptional situations has been deemed ineligible according to the program's guidelines. This form ensures clear communication about the provider's eligibility status and helps maintain consistency in the application of workweek limitations.

Form LIC 508B is a criminal record statement used by participants in the Long-Term Care Ombudsman Program in California. The form is completed by the program participant and includes questions regarding criminal history, convictions, and any pertinent legal matters. By utilizing this form, the Long-Term Care Ombudsman Program obtains information for background checks, ensuring the suitability of participants in advocating for the rights and well-being of individuals receiving long-term care services.

Form IHSS-E-003 is a Program Notice to Recipient for Discontinuance of Exemption from Workweek Limitations for Extraordinary Circumstances under the In-Home Supportive Services (IHSS) program. It is used to inform IHSS recipients that their exemption from workweek limitations, which allows their assigned provider to work more hours than usual, is being discontinued due to the resolution of extraordinary circumstances. This form ensures that the recipient is aware of the change and can make necessary adjustments to their care plan accordingly.

Form IHSS-E-002 is a Program Notice to Provider for Discontinuance of Exemption from Workweek Limitations for Extraordinary Circumstances under the In-Home Supportive Services (IHSS) program. This form is used to notify IHSS service providers that their exemption from workweek limitations, which allow them to exceed the standard weekly working hours, is being discontinued due to the resolution of extraordinary circumstances.

Form ICPC-100B, called the "Interstate Compact Report On Child's Placement Status," is a crucial document within the ICPC framework. It is completed by the receiving agency responsible for overseeing the care and well-being of a child who has been placed in their state through the ICPC process. This report provides updates on the child's adjustment, health, education, and any significant changes in their circumstances.