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DCFS Forms

Forms

Title Type Posted Date
Agency Generated Invoice Form DOC 04/27/2020
CFS-305 Personal Property Inventory Log PDF 04/13/2020
CFS-592 ICPC Financial and Medical Plan PDF 04/09/2020
CFS-99 FASD Screening Referral Form PDF 02/14/2020
CFS-434 - Mutual Consent Voluntary Adoption Registry PDF 02/06/2020
CFS-050-E - DCFS Volunteer Agreement PDF 01/29/2020
CFS-050-B - DCFS Volunteer Checklist PDF 01/29/2020
CFS-155 Unable to Locate Checklist PDF 01/29/2020
CFS-050-A - Volunteer Opportunities PDF 01/29/2020
CFS-050-C - Volunteer Application PDF 01/29/2020
CFS-435-A Subsidized Guardianship Program Application and Checklist PDF 01/08/2020
CFS-232-T2 True But Exempt Child Maltreatment Investigative Determination Notice to Offender PDF 01/03/2020
CFS-435-C Subsidized Guardianship Program Special Subsidy Request PDF 01/02/2020
CFS-328-C Name Removal Request and Determination Letter DOC 01/02/2020
CFS-101 - Plan of Safe Care PDF 01/02/2020
CFS-316 - Request for Child Maltreatment Central Registry Check PDF 01/02/2020
CFS-435-H Notice of Modification or Termination to Subsidized Guardianship Agreement PDF 01/02/2020
CFS-435-G Annual Progress Report and Subsidized Guardianship Agreement Review PDF 01/02/2020
CFS-435-B Notification of Subsidized Guardianship Program Denial PDF 01/02/2020
CFS-435-D Recommendation for Finalization of Guardianship PDF 01/02/2020
CFS-435-F Subsidized Guardianship Agreement PDF 01/02/2020
CFS-224-T5 True but Exempted Investigative Determination Notice to Parents, Guardians of Alleged Offender (14-17) PDF 01/02/2020
CFS-223-T5 True but Exempted Child Maltreatment Investigative Determination Notice to Alleged Juvenile Offender (14-17) PDF 01/02/2020
CFS-309 Internal Review of Child Near Fatality, Fatality PDF 01/02/2020
CFS-0000 - Cell Phone Order or Replacement Form PDF 12/12/2019
CFS-433 Individualized Adoption Recruitment Plan PDF 12/10/2019
CFS-205-A Notice of Child Maltreatment Allegation to Parents, Guardians, Current Foster Parent of Alleged Victim in Care PDF 12/10/2019
CFS-472 Out-of-State Child Maltreatment Registry Check Acknowledgement and Consent DOC 12/10/2019
CFS-364 Therapeutic Foster Care Justification PDF 12/10/2019
CFS-1944 DCFS Certification of Unavailability of a State Vehicle PDF 12/10/2019
CFS-232-EH Instructions PDF 12/10/2019
CFS-204-A Marshallese Notice of Child Maltreatment Allegation to Parents, Guardians and Foster Parents of an Alleged Offender PDF 12/10/2019
CFS-245-U Spanish Notice of Unsubstantiated Child Maltreatment Inv Determination to Legal Parents, Guardians, Current FP of AV PDF 12/10/2019
CFS-002 - Life Plan & Agreement for Youth in Transition PDF 12/10/2019
CFS-100 - Authorization for Release of Information for Differential Response PDF 12/10/2019
CFS-200 - Protection Plan (Spanish) PDF 12/10/2019
CFS-205-A Spanish Notice of Child Maltreatment Allegation to Parents, Guardians, Current Foster Parent of Alleged Victim in Care PDF 12/10/2019
CFS-214-R Instructions PDF 12/10/2019
CFS-222-T - Notice of True Determination to Facility Director PDF 12/10/2019
CFS-223-T4 Child Maltreatment True Investigative Determination Notice to Alleged Juvenile Offender (Currently 18 or older) PDF 12/10/2019
CFS-224-T3 Spanish Child Maltreatment True Investigative Determination Notice to Parents, Guardians of Alleged Offender (14-17) PDF 12/10/2019
CFS-225-T2_Instructions PDF 12/10/2019
CFS-230-T True Notice to Director, MDT, Circuit Judge, or Counsel in DN or FINS for Alleged Offender or Alleged Victim PDF 12/10/2019
CFS-232-T1 Child Maltreatment True Investigative Determination Notice to Alleged Adult Offender PDF 12/10/2019
CFS-232-T2 Spanish True But Exempt Child Maltreatment Investigative Determination Notice to Offender PDF 12/10/2019
CFS-240-U1 Spanish Notice of Unsubstantiated Child Maltreatment Investigative Determination to Alleged UJO (Under 14) PDF 12/10/2019
CFS-242-U - Instructions PDF 12/10/2019
CFS-245-U1 - Instructions PDF 12/10/2019
CFS-250-U Notice of Unsub Child Maltreatment Investigative Det to Director, MDT, Judge or Counsel for AO or AV PDF 12/10/2019
CFS-263-O Notice of Overturned True Child Maltreatment Investigative Determination to Facility Director PDF 12/10/2019
CFS-265-O2 - Instructions PDF 12/10/2019
CFS-270-O - Instructions PDF 12/10/2019
CFS-281-N Notice of Name Placement on Central Registry to Law Enforcement, Prosecuting Attorney PDF 12/10/2019
CFS-285-N Notice of Name Placement on Central Registry to Victim, Legal Parents Guardian, Current FP of Victim PDF 12/10/2019
CFS-289-N Notice of Name Placement on Central Registry to AAL and CASA of Child in FH where Maltreatment Reported PDF 12/10/2019
CFS-292-N - Notice of Name Placement on Central Registry to Offender PDF 12/10/2019
CFS-296-N - Instructions PDF 12/10/2019
CFS-303 - Out of State Placement PDF 12/10/2019
CFS-321 - Referral for Investigation PDF 12/10/2019
CFS-323-A - Instructions PDF 12/10/2019
CFS-327 Notification of Name Removal from the Central Registry PDF 12/10/2019
CFS-336 Expiration of Protective Custody Parental Notification PDF 12/10/2019
CFS-343 - Spanish Notification of Court Appearance PDF 12/10/2019
CFS-352 - Instructions PDF 12/10/2019
CFS-363 - Foster Parent, Adoptive Parent or Applicant Smoking Certification PDF 12/10/2019
CFS-368 - Instructions PDF 12/10/2019
CFS-384 - Instructions PDF 12/10/2019
CFS-398 Approval to Place Children 12 and Under in an Emergency Shelter, Shelter Extension Approval PDF 12/10/2019
CFS-414 - Adoption Services Change of Status PDF 12/10/2019
CFS-426 - Statement of Income and Resources for Adoption Subsidy PDF 12/10/2019
CFS-429 - Special Adoption Subsidy Determination PDF 12/10/2019
CFS-451 - Foster Parent Re-Evaluation DOC 12/10/2019
CFS-462- Initial Foster Home Agreement PDF 12/10/2019
CFS-471 - Instructions PDF 12/10/2019
CFS-475-E Complaint Against Foster Family Other Than Child Maltreatment PDF 12/10/2019
CFS-487 Application for Title IV-E Payments, Medicaid PDF 12/10/2019
CFS-491 - Consent for Use of Funds and Resources PDF 12/10/2019
CFS-509-A Recommendation To The Child Welfare Agency Review Board PDF 12/10/2019
CFS-4331 Educational Leave Contract PDF 12/10/2019
CFS-6024 Permanency Planning Court Report Instructions PDF 12/10/2019
CFS-6096 ICPC Case Manager Statement Reg 7 PDF 12/10/2019
Foster Parent ITNA Tally Sheet PDF 12/10/2019
ICPC-101 - ICPC Sending State Priority Home Study Request PDF 12/10/2019
SS-5 - Application for a Social Security Card PDF 12/10/2019
CBC Handling Instructions PDF 12/10/2019
CFS-508-B Volunteer Denial Based on CBC DOC 12/10/2019
CFS-428-A Instructions PDF 12/10/2019
CFS-329-B Foster Child Maltreatment Disclosure Case Briefing Summary by Primary Staff PDF 12/10/2019
CFS-213-A Spanish School District Prohibition from Notifying a Parent, Guardian, or Custodian of a Child Maltreatment Investigation PDF 12/10/2019
CFS-003 - Checklist for Youth Exiting Care PDF 12/10/2019
CFS-201-A - Notice of Child Maltreatment Allegation to Law Enforcement and Prosecuting Attorney PDF 12/10/2019
CFS-205-A Marshallese Notice of Child Maltreatment Allegation to Parents, Guardians, Current Foster Parent of Alleged Victim in Care PDF 12/10/2019
CFS-212-A Instructions PDF 12/10/2019
CFS-214-R1 Follow Up with Employer, Volunteer Coordinator, Licensing or Registering on Maltreatment Allegations PDF 12/10/2019
CFS-222-T - Instructions PDF 12/10/2019
CFS-223-T4 - Instructions PDF 12/10/2019
CFS-224-T4 Child Maltreatment True Investigative Determination Notice to Current FP of AO in Care PDF 12/10/2019
CFS-225-T2 Spanish Child Maltreatment True Investigative Determination Notice to Current Foster Parent of AV in Care PDF 12/10/2019
CFS-230-T - Instructions PDF 12/10/2019
CFS-232-T1A Witness Statement of Notice of Investigative Determination PDF 12/10/2019
CFS-233-T - Child Maltreatment Expedited Hearing Notice to Alleged Offender PDF 12/10/2019
CFS-240-U2 Notice of Unsubstantiated Child Maltreatment Investigative Determination to Alleged Juvenile Offender (14-17) PDF 12/10/2019
CFS-243-U Notice of Unsubstantiated Child Maltreatment Investigative Determination to Facility Director PDF 12/10/2019
CFS-245-U1 Spanish Notice of Unsubstantiated Child Maltreatment Investigative Determination to Alleged Victim PDF 12/10/2019
CFS-250-U - Instructions PDF 12/10/2019
CFS-263-O - Instructions PDF 12/10/2019
CFS-266-O Notice of Overturned True Child Maltreatment Inv Det to Judge, AAL, CASA, Counsel in DN or FINS Case for AV PDF 12/10/2019
CFS-272-O Notice of Overturned True Child Maltreatment Investigative Determination to Alleged Offender PDF 12/10/2019
CFS-281-N - Instructions PDF 12/10/2019
CFS-285-N - Instructions PDF 12/10/2019
CFS-289-N - Instructions PDF 12/10/2019
CFS-292-N - Instructions PDF 12/10/2019
CFS-299 - Investigation Checklist for Supervisors PDF 12/10/2019
CFS-304 - Justification for Special Board Rate Form PDF 12/10/2019
CFS-313 Office of Policy and Legal Services Review of Administrative Hearing Investigative Determination PDF 12/10/2019
CFS-321 - Instructions PDF 12/10/2019
CFS-323-A Spanish Notice to Adult Relatives by Blood, Adoption or Marriage that a Child has been taken into DCFS Custody PDF 12/10/2019
CFS-327 Spanish Notification of Name Removal from the Central Registry PDF 12/10/2019
CFS-330 - Protective Services Alert Notification PDF 12/10/2019
CFS-336 Spanish Expiration of Protective Custody Parental Notification PDF 12/10/2019
CFS-345 - Intensive Family Services Referral PDF 12/10/2019
CFS-353 - Requested Medical Records Log DOC 12/10/2019
CFS-363 - Instructions PDF 12/10/2019
CFS-370 - Residence Checklist for Youth PDF 12/10/2019
CFS-400 - Separated Sibling Contact Report for Foster Parents PDF 12/10/2019
CFS-414 - Instructions PDF 12/10/2019
CFS-426 - Instructions PDF 12/10/2019
CFS-429 - Instructions PDF 12/10/2019
CFS-445 - Foster Home Needs Assessment DOC 12/10/2019
CFS-451 - Instructions PDF 12/10/2019
CFS-462-A Foster Home Agreement Addendum PDF 12/10/2019
CFS-474 - Provisional Foster Home Orientation Checklist PDF 12/10/2019
CFS-475-F True Reports of Child Maltreatment Against Foster Family Members PDF 12/10/2019
CFS-487 - Instructions PDF 12/10/2019
CFS-492 ICAMA Medicaid Redetermination PDF 12/10/2019
CFS-509-B Request For Alternative Compliance or Policy Waiver PDF 12/10/2019
Meal Voucher Authorization for “FEED THE KIDS” Program PDF 12/10/2019
CFS-4332 - Child Welfare Student Stipend Application PDF 12/10/2019
CFS-6091 ICPC Parent-Relative Home Study Checklist PDF 12/10/2019
ICPC-30 - ICPC Supervision Report-30 day PDF 12/10/2019
Missing Receipt for P-Card Transaction Form PDF 12/10/2019
VR-7 - Birth Certificate Application PDF 12/10/2019
CFS-010 Review and Approval for Official Business Mileage in Excess of 500 Miles PDF 12/10/2019
CFS-252-U Spanish Notice of Unsubstantiated Child Maltreatment Investigative Determination to Alleged Offender PDF 12/10/2019
DHS-0359 DHS Systems Security Access Request DOC 12/10/2019
CFS-329-A Foster Child Maltreatment Disclosure Briefing Summary by Secondary Staff PDF 12/10/2019
CFS-154 Out Of State Information Request PDF 12/10/2019
W-9 Request for Taxpayer Identification Number and Certification PDF 12/10/2019
CFS-004 - Request for After Care Support PDF 12/10/2019
CFS-102 - DDS Medicaid Waiver Client Referral Form PDF 12/10/2019
CFS-201-A Instructions PDF 12/10/2019
CFS-206-A Notice of Child Maltreatment Allegation to AAL, CASA, Counsel in DN or FINS Case of AV PDF 12/10/2019
CFS-212-A Notice of Child Maltreatment Allegation to Alleged Offender (Marshallese) PDF 12/10/2019
CFS-214-R1 Instructions PDF 12/10/2019
CFS-223-T1 Child Maltreatment True Investigative Determination Notice to UJO (under 14) PDF 12/10/2019
CFS-223-T4 Spanish Child Maltreatment True Investigative Determination Notice to Alleged Juvenile Offender (Currently 18 or older) PDF 12/10/2019
CFS-224-T4_Instructions PDF 12/10/2019
CFS-226-T1 Child Maltreatment True Inv Determination Notice to Circuit Judge, AAL, CASA, Counsel in DN or FINS Case of AV PDF 12/10/2019
CFS-231-T Child Maltreatment True Investigative Determination Notice to School Where Victim is Enrolled PDF 12/10/2019
CFS-232-T1A Spanish Witness Statement of Notice of Investigative Determination PDF 12/10/2019
CFS-233-T - Instructions PDF 12/10/2019
CFS-243-U Instructions PDF 12/10/2019
CFS-246-U Notice of Unsub Child Maltreatment Inv Det to Circuit Judge, AAL, CASA, Counsel in DN or FINS of Alleged Victim PDF 12/10/2019
CFS-252-U Notice of Unsubstantiated Child Maltreatment Investigative Determination to Alleged Offender PDF 12/10/2019
CFS-264-O Notice of Overturned True Child Maltreatment Investigative Determination to Legal Parents, Legal Guardians of AO PDF 12/10/2019
CFS-266-O Instructions PDF 12/10/2019
CFS-272-O - Instructions PDF 12/10/2019
CFS-283-N - Notice of Name Placement on Central Registry to Facility Director PDF 12/10/2019
CFS-285-N Spanish Notice of Name Placement on Central Registry to Victim, Legal Parents Guardian, Current FP of Victim PDF 12/10/2019
CFS-290-N Notice of Name Placement on Central Registry to Director, MDT Coordinator, Judge, Counsel DN FINS Offender PDF 12/10/2019
CFS-292-N - (Spanish) Notice of Name Placement on Central Registry to Offender PDF 12/10/2019
CFS-300 Parent and Parent Counsel Notification of Changes In Out-Of-Home Placement PDF 12/10/2019
CFS-304 - Instructions PDF 12/10/2019
CFS-322 - Homemaker Referral DOC 12/10/2019
CFS-327-A Physical Documentation-Body Diagram DOC 12/10/2019
CFS-336 Marshallese Expiration of Protective Custody Parental Notification PDF 12/10/2019
CFS-346 - Background Check Results PDF 12/10/2019
CFS-353 - Instructions PDF 12/10/2019
CFS-363 - Spanish Foster Parent, Adoptive Parent or Applicant Smoking Certification PDF 12/10/2019
CFS-376 - Authorization for Billing & Trust Account Action PDF 12/10/2019
CFS-388 Application and Agreement to Participate in DCFS FC Driver’s License Car Insurance Reimbursement Program PDF 12/10/2019
CFS-401 - 90 Day Case Review for Separated Siblings Summary PDF 12/10/2019
CFS-431 - Certification of Adoption Subsidy Eligibility PDF 12/10/2019
CFS-446 - In Home Consultation Visit Report PDF 12/10/2019
CFS-452 - Provisional Foster Home Verification PDF 12/10/2019
CFS-465 - Foster Parent Orientation Checklist PDF 12/10/2019
CFS-474 - Instructions PDF 12/10/2019
CFS-475-G Checklist for Foster Home Closure PDF 12/10/2019
CFS-488 - Title IV-E Eligibility Summary DOC 12/10/2019
CFS-493 - Title IV E Medicaid Redetermination DOC 12/10/2019
CFS-590 - Invitation to Family-Centered Meeting PDF 12/10/2019
CFS-594 - Instructions PDF 12/10/2019
CFS-467 - Adoption Recruitment Agreement PDF 12/10/2019
CFS-6092 ICPC Custody Placement Home Study Request Checklist PDF 12/10/2019
DCFS P-CARD FV-4 PDF 12/10/2019
ICPC-90 - ICPC Supervision Report-90 Day PDF 12/10/2019
NYTD Survey PDF 12/10/2019
Arkansas State Vehicle Safety Program PDF 12/10/2019
CFS-008 Proof of Foster Care Documentation PDF 12/10/2019
CFS-264-O Spanish Notice of Overturned True Child Maltreatment Investigative Determination to Legal Parents, Legal Guardians of AO PDF 12/10/2019
DHS P-Card Application and Agreement PDF 12/10/2019
CFS-270-O Notice of Overturned True Child Maltreatment Inv Det to Director, MDT, Circuit Judge PDF 12/10/2019
CFS-323-B Notice to Fictive Kin that a Child has been Taken into DCFS Custody DOC 12/10/2019
CFS-428-B Instructions PDF 12/10/2019
VSP 593 Instructions PDF 12/10/2019
Cell Phone Cancellation of Service Instructions PDF 12/10/2019
CFS-005 - Arkansas Identification Card Authorization Voucher PDF 12/10/2019
CFS-103 - Referral for Adolescent Sexual Adjustment Project Assessment PDF 12/10/2019
CFS-202-A Notice of Child Maltreatment Allegation to Facility or Division Director PDF 12/10/2019
CFS-206-A Instructions - Notice of Child Maltreatment Allegation to AAL, CASA, Counsel in DN or FINS Case of AV PDF 12/10/2019
CFS-212-A Notice of Child Maltreatment Allegation to Alleged Offender (Spanish) PDF 12/10/2019
CFS-215-R - Risk Determination of Certain Individuals under Care of Alleged Offender PDF 12/10/2019
CFS-223-T1 Instructions PDF 12/10/2019
CFS-224-T1 Child Maltreatment True Investigative Determination Notice to Legal Parents, Legal Guardians of UJO PDF 12/10/2019
CFS-224-T4 Spanish Child Maltreatment True Investigative Determination Notice to Current FP of AO in Care PDF 12/10/2019
CFS-226-T1 - Instructions PDF 12/10/2019
CFS-231-T- Instructions PDF 12/10/2019
CFS-232-T1 Marshallese Child Maltreatment True Investigative Determination Notice to Alleged Adult Offender PDF 12/10/2019
CFS-233-T - (Spanish) Child Maltreatment Expedited Hearing Notice to Alleged Offender PDF 12/10/2019
CFS-244-U Notice of Unsubstantiated Child Maltreatment Investigative Determination to Legal Parents, Legal Guardians of AO PDF 12/10/2019
CFS-246-U - Instructions PDF 12/10/2019
CFS-252-U - Instructions PDF 12/10/2019
CFS-264-O - Instructions PDF 12/10/2019
CFS-324 Checklist of Homemaker’s Activities DOC 12/10/2019
CFS-272-O Spanish Notice of Overturned True Child Maltreatment Investigative Determination to Alleged Offender PDF 12/10/2019
CFS-283-N - Instructions PDF 12/10/2019
CFS-285-N Marshallese Notice of Name Placement on Central Registry to Victim, Legal Parents Guardian, Current FP of Victim PDF 12/10/2019
CFS-290-N - Instructions PDF 12/10/2019
CFS-294-N Notice of Name Placement on Central Registry to Offender, Licensing, Employer, Volunteer Coordinator PDF 12/10/2019
CFS-300 - Instructions PDF 12/10/2019
CFS-316 - Instructions PDF 12/10/2019
CFS-322 - Instructions PDF 12/10/2019
CFS-323-B - Instructions PDF 12/10/2019
CFS-328-A Request for Name Removal from Central Registry PDF 12/10/2019
CFS-333 - Client Information Sheet for Cash Assistance and Foster Care Incidentals DOC 12/10/2019
CFS-340 Permanency Roundtable Referral Form PDF 12/10/2019
CFS-347 Intensive Family Services Family Counselor’s Time Record DOC 12/10/2019
CFS-354 Team Decision Making Meeting Sign In Sheet for Participants PDF 12/10/2019
CFS-365 Receipt for Medical Passport PDF 12/10/2019
CFS-377 - Facility Trust Account Report PDF 12/10/2019
CFS-388 - Instructions PDF 12/10/2019
CFS-404 - General Medical Report PDF 12/10/2019
CFS-419 - Foster Family Support System (FFSS) Information PDF 12/10/2019
CFS-427 - Instructions PDF 12/10/2019
CFS-431 - Instructions PDF 12/10/2019
CFS-446 - Instructions PDF 12/10/2019
CFS-455 Request and Consent for Department of Health Services PDF 12/10/2019
CFS-465 - Spanish Foster Parent Orientation Checklist PDF 12/10/2019
CFS-476 - DCFS Training Completion Certificate PDF 12/10/2019
CFS-488 - Instructions PDF 12/10/2019
CFS-494 - Notification of Adoption for Medicaid PDF 12/10/2019
CFS-590 - Instructions PDF 12/10/2019
CFS-595 - Meal Authorization Log for “FEED THE KIDS” Program PDF 12/10/2019
CFS-6010 Addendum - A1 Case Plan Visitation Plan Addendum DOC 12/10/2019
CFS-6092 - ICPC Cover Letter PDF 12/10/2019
DHS-0081 - Consent for Release of Information PDF 12/10/2019
ICPC-100A - Interstate Compact Placement Request PDF 12/10/2019
OPLS-410 Consent to Termination of Parental Rights PDF 12/10/2019
VSP-001 - Authorization to Operate State Vehicles and Private Vehicles on State Business PDF 12/10/2019
CFS-269-O Notice of Overturned True Child Maltreatment Inv Det to AAL, CASA of Child in FH where Maltreatment Reported PDF 12/10/2019
Child Care Referral Template - May 2008 PDF 12/10/2019
CFS-417 Consent to Adoption PDF 12/10/2019
CFS-301 Authorization to Provide Transportion PDF 12/10/2019
CFS-508-A Resource Parent Denial Based on CBC Results DOC 12/10/2019
CFS-452 Spanish Provisional Foster Home Verification PDF 12/10/2019
Cell Phone Ordering Instructions PDF 12/10/2019
CFS-007 - Youth Acknowledgment of Rights in Foster Care PDF 12/10/2019
CFS-149 - DCFS Prevention & Support Unit Supply Order PDF 12/10/2019
CFS-202-A Instructions PDF 12/10/2019
CFS-209-A - Notice of Child Maltreatment Allegation to AAL or CASA of Child in Foster Home PDF 12/10/2019
CFS-213-A School District Prohibition from Notifying a Parent, Guardian, or Custodian of a Child Maltreatment Investigation PDF 12/10/2019
CFS-215-R - Instructions PDF 12/10/2019
CFS-223-T1 Spanish Child Maltreatment True Investigative Determination Notice to UJO (under 14) PDF 12/10/2019
CFS-224-T1 - Instructions PDF 12/10/2019
CFS-225-T1 Child Maltreatment True Investigative Determination Notice to Victim, Legal Parents and Guardians of AV PDF 12/10/2019
CFS-228-T Child Maltreatment True Investigative Determination Notice to AAL and CASA of Alleged Offender PDF 12/10/2019
CFS-232-T1 Instructions PDF 12/10/2019
CFS-232-T1 Spanish Child Maltreatment True Investigative Determination Notice to Alleged Adult Offender PDF 12/10/2019
CFS-234-T Child Maltreatment True Investigative Determination Notice to Licensing, Employer, Volunteer Coordinator PDF 12/10/2019
CFS-240-U2 Spanish Notice of Unsubstantiated Child Maltreatment Investigative Determination to Alleged Juvenile Offender (14-17) PDF 12/10/2019
CFS-248-U Notice of Unsubstantiated Child Maltreatment Investigative Determination to AAL and CASA for Alleged Offender PDF 12/10/2019
CFS-252-U Marshallese Notice of Unsubstantiated Child Maltreatment Investigative Determination to Alleged Offender PDF 12/10/2019
CFS-265-O1 Notice of Overturned True Child Maltreatment Inv Det to Victim, Legal Parent, Legal Guardian of Alleged Victim PDF 12/10/2019
CFS-268-O Instructions PDF 12/10/2019
CFS-205-A Instructions Notice of Child Maltreatment Allegation PDF 12/10/2019
CFS-284-N Notice of Name Placement on Central Registry to Parents and Legal Guardians of Juvenile Offender (14-17) PDF 12/10/2019
CFS-286-N Notice of Name Placement on Central Registry to Circuit Judge, AAL, CASA, Counsel in DN or FINS Case of Victim PDF 12/10/2019
CFS-291-N1 - Notice of Name Placement on Central Registry to School Where Victim Is Enrolled PDF 12/10/2019
CFS-294-N - Instructions PDF 12/10/2019
CFS-300 Spanish Parent and Parent Counsel Notification of Changes In Out-Of-Home Placement PDF 12/10/2019
CFS-306 Documentation of Child’s Medical Episode Related to Near Fatality PDF 12/10/2019
CFS-317 - Off-Site Worker’s Safety Log DOC 12/10/2019
CFS-323 Protective Custody, Parental Notification PDF 12/10/2019
CFS-323-B Spanish Notice to Fictive Kin that a Child has been Taken into DCFS Custody PDF 12/10/2019
CFS-328-A Instructions PDF 12/10/2019
CFS-341 Certification of Absence of Criminal Record PDF 12/10/2019
CFS-347 - Instructions PDF 12/10/2019
CFS-355 Team Decision Making Team Meeting Decision Report PDF 12/10/2019
CFS-365 - Instructions PDF 12/10/2019
CFS-379 Close Out or Overpayment Notification PDF 12/10/2019
CFS-389 Foster Care Driver’s License and Car Insurance Reimbursement Program Central Office Approval Cert Statement PDF 12/10/2019
CFS-408 - Federal Parent Locator System Information PDF 12/10/2019
CFS-420 - Legal Risk Adoption Placement Agreement PDF 12/10/2019
CFS-428-A Adoption Assistance Agreement for State Funded Subsidy Payments PDF 12/10/2019
CFS-432 - Recommendation for Finalization of an Adoption PDF 12/10/2019
CFS-448 - Privacy and Use of Surveillance in Resource Homes DOC 12/10/2019
CFS-455 - Instructions PDF 12/10/2019
CFS-467 - Instructions PDF 12/10/2019
Initial Checklist for Foster Adoptive Home Assessment PDF 12/10/2019
CFS-480 Alternate Compliance of Water Supply Agreement for Foster Homes PDF 12/10/2019
CFS-489 - Foster Parent Request for Consideration to Adopt PDF 12/10/2019
CFS-494 - Instructions PDF 12/10/2019
CFS-590 - (Marshallese) Invitation to Family-Centered Meeting PDF 12/10/2019
CFS-597 - Request to Open a Medicaid Account on an ICPC Case PDF 12/10/2019
CFS-6010 Addendum - B1 Independent Living Skills Plan Addendum PDF 12/10/2019
CFS-6092 - ICPC Social Summary PDF 12/10/2019
DHS-4000 - Authorization to Disclose Health Information PDF 12/10/2019
ICPC-100A - Instructions PDF 12/10/2019
OPLS-410 Consent to Termination of Parental Rights (Spanish) PDF 12/10/2019
VSP-002 - Authorization to Obtain Traffic Violation Record PDF 12/10/2019
CFS-596 Verification for IV-E ICPC Medicaid PDF 12/10/2019
CFS-366-B Initial Health Screen Part 2 PDF 12/10/2019
CFS-274-O Notice of Overturned True Child Maltreatment Inv Det to Licensing, Employer, Volunteer Coordinator PDF 12/10/2019
CFS-474 Spanish Provisional Foster Home Orientation Checklist DOC 12/10/2019
CFS-450-A Non-Custodial Parent Info and Questionnaire PDF 12/10/2019
DHS-4017 US Spanish DOC 12/10/2019
CFS-232-EH Request for Expedited Administrative Hearing PDF 12/10/2019
CFS-007 - Youth Acknowledgment of Rights in Foster Care (Spanish) PDF 12/10/2019
CFS-050-D - Confidentiality Statement for DCFS Volunteer PDF 12/10/2019
CFS-150 - Drug and Alcohol Screen Results PDF 12/10/2019
CFS-204-A Notice of Child Maltreatment Allegation to Parents, Guardians and Foster Parents of an Alleged Offender PDF 12/10/2019
CFS-209-A - Instructions PDF 12/10/2019
CFS-220 - DCFS True Investigation File Cover Sheet PDF 12/10/2019
CFS-223-T3 Child Maltreatment True Investigative Determination Notice to Alleged Juvenile Offender (14-17) PDF 12/10/2019
CFS-224-T1 Spanish Child Maltreatment True Investigative Determination Notice to Legal Parents, Legal Guardians of UJO PDF 12/10/2019
CFS-225-T1 - Instructions PDF 12/10/2019
CFS-228-T - Instructions PDF 12/10/2019
CFS-234-T - Instructions PDF 12/10/2019
CFS-241-U Notice of Unsubstantiated Child Maltreatment Investigative Determination to Law Enforcement, Prosecuting Attorney PDF 12/10/2019
CFS-245-U Notice of Unsubstantiated Child Maltreatment Inv Determination to Legal Parents, Guardians, Current FP of AV PDF 12/10/2019
CFS-248-U - Instructions PDF 12/10/2019
CFS-254-U_Instructions PDF 12/10/2019
CFS-265-O1 Instructions PDF 12/10/2019
CFS-274-O - Instructions PDF 12/10/2019
CFS-284-N - Instructions PDF 12/10/2019
CFS-286-N - Instructions PDF 12/10/2019
CFS-291-N1 - Instructions PDF 12/10/2019
CFS-295-N Notice of Name Placement on Central Registry to Child Safety Center Involved in Investigation of Maltreatment PDF 12/10/2019
CFS-300A AAL, CASA, and Youth Notification of Changes in OOH Placement PDF 12/10/2019
CFS-306-A Documentation of Initial Near Fatality Subsequently Resulting in Fatality PDF 12/10/2019
CFS-317 - Instructions PDF 12/10/2019
CFS-323 Marshallese Protective Custody, Parental Notification PDF 12/10/2019
CFS-324 - Instructions PDF 12/10/2019
CFS-328-B Request for Name Removal from the Central Registry by Juvenile Offender PDF 12/10/2019
CFS-334 - Foster Care Services Authorization for Billing PDF 12/10/2019
CFS-341 Spanish Certification of Absence of Criminal Record PDF 12/10/2019
CFS-351 - Initial Dental Examination DOC 12/10/2019
CFS-360 Request for Conference or Training PDF 12/10/2019
CFS-367 Specialized Placement Application PDF 12/10/2019
CFS-380 - Trust Account Invoice PDF 12/10/2019
CFS-408 - Instructions PDF 12/10/2019
CFS-420 - Instructions PDF 12/10/2019
CFS-428-B Adoption Assistance Agreement for Federal IV-E Funded Assistance PDF 12/10/2019
CFS-432 - Instructions PDF 12/10/2019
CFS-435-E Consent for Guardianship by a Minor Over the Age of 12 PDF 12/10/2019
CFS-449 - Confidentiality and Use of Social Media in Resource Homes DOC 12/10/2019
CFS-456 - Birth Family Background Information DOC 12/10/2019
CFS-470 - Selection of Adoptive Family PDF 12/10/2019
CFS-475-B Quarterly Monitoring Checklist for Foster Home PDF 12/10/2019
CFS-480 - Instructions PDF 12/10/2019
CFS-489 - Instructions PDF 12/10/2019
CFS-495 Title IV-E Eligibility Redetermination Summary PDF 12/10/2019
CFS-590 - (Spanish) Invitation to Family-Centered Meeting PDF 12/10/2019
CFS-1136 - DCFS Employee Orientation Checklist Addendum DOC 12/10/2019
CFS-6093 - ICPC Foster Care Home Study Check List PDF 12/10/2019
CFS-208-A Notice of Child Maltreatment Allegation to AAL and CASA of Alleged Offender PDF 12/10/2019
VSP-003 - Ready to Open Form PDF 12/10/2019
CFS-268-O Notice of Overturned True Child Maltreatment Investigative Determination to AAL, CASA of Alleged Offender PDF 12/10/2019
CFS-366 Initial Health Screen Part 1 PDF 12/10/2019
CFS-212-A Notice of Child Maltreatment Allegation to Alleged Offender PDF 12/10/2019
CFS-425 Spanish Application for Adoption Subsidy PDF 12/10/2019
CFS-427 Determination of Eligibility of Adoption Subsidy PDF 12/10/2019
CFS-493_Instructions PDF 12/10/2019
CFS-254-U Notice of Unsubstantiated Child Maltreatment Inv Det to AO Employer, Licensing, Volunteer Coordinator 12/10/2019
CFS-0000-A - Cell Phone Agreement PDF 12/10/2019
Request for Service-Encumbrance Non-Placement Services PDF 12/10/2019
CFS-200 - Protection Plan PDF 12/10/2019
CFS-204-A Instructions PDF 12/10/2019
CFS-210-A Notice of Child Maltreatment Allegation to MDT Coordinator PDF 12/10/2019
CFS-213-A Marshallese School District Prohibition from Notifying a Parent, Guardian, or Custodian of a Child Maltreatment Investigation PDF 12/10/2019
CFS-221-T Child Maltreatment True Investigative Determination Notice to Law Enforcement and Prosecuting Attorney PDF 12/10/2019
CFS-223-T3 - Instructions PDF 12/10/2019
CFS-224-T3 Child Maltreatment True Investigative Determination Notice to Parents, Guardians of Alleged Offender (14-17) PDF 12/10/2019
CFS-225-T1 Spanish Child Maltreatment True Investigative Determination Notice to Victim, Legal Parents and Guardians of AV PDF 12/10/2019
CFS-229-T Det. Notice to AAL and CASA When AO and AV are in same Foster Home PDF 12/10/2019
CFS-232-T PH Request for Preliminary Administrative Hearing PDF 12/10/2019
CFS-232-T2 - Instructions PDF 12/10/2019
CFS-240-U1 Marshallese Notice of Unsubstantiated Child Maltreatment Investigative Determination to Alleged UJO (Under 14) PDF 12/10/2019
CFS-241-U - Instructions PDF 12/10/2019
CFS-245-U - Instructions PDF 12/10/2019
CFS-249-U Notice of Unsubstantiated Child Maltreatment Inv Det to AAL and CASA of Child in FH Maltreatment Reported PDF 12/10/2019
CFS-261-O Notice of Overturned True Child Maltreatment Investigative Determination to Law Enforcement, Prosecuting Attorney PDF 12/10/2019
CFS-265-O1 Spanish Notice of Overturned True Child Maltreatment Inv Det to Victim, Legal Parent, Legal Guardian of Alleged Victim PDF 12/10/2019
CFS-269-O Instructions PDF 12/10/2019
CFS-275-O Notice of Overturned True Child Maltreatment Investigative Determination to Child Safety Center Involved PDF 12/10/2019
CFS-284-N Marshallese Notice of Name Placement on Central Registry to Parents and Legal Guardians of Juvenile Offender (14-17) PDF 12/10/2019
CFS-288-N Notice of Name Placement on Central Registry to AAL and CASA of Offender PDF 12/10/2019
CFS-291-N2 - Notice of Name Placement on Central Registry to School Where Offender Is Enrolled PDF 12/10/2019
CFS-295-N - Instructions PDF 12/10/2019
CFS-300A - Instructions PDF 12/10/2019
CFS-307 Child Near Fatality, Fatality Disclosure Case Briefing Summary PDF 12/10/2019
CFS-320 - Administrative Hearing Statement PDF 12/10/2019
CFS-323 Spanish Protective Custody, Parental Notification PDF 12/10/2019
CFS-325 - Notification of Complaint Other than Child Maltreatment PDF 12/10/2019
CFS-328-B Instructions PDF 12/10/2019
CFS-334 - Instructions PDF 12/10/2019
CFS-342 Criminal Background Check PDF 12/10/2019
CFS-351 - Instructions PDF 12/10/2019
CFS-362 - Medi-Alert to Foster Care Provider PDF 12/10/2019
CFS-367 - Instructions PDF 12/10/2019
CFS-381 - Training Record Log PDF 12/10/2019
CFS-409 Foster and Adoptive Family Preference Checklist PDF 12/10/2019
CFS-423 - Certificate of Service PDF 12/10/2019
CFS-450 Prospective Provisional Foster Parent Information and Questionnaire PDF 12/10/2019
CFS-457 - Hospital Data PDF 12/10/2019
CFS-470 - Instructions PDF 12/10/2019
CFS-475-C Reevaluation Checklist for Foster Homes PDF 12/10/2019
CFS-484 - Landlord Notification of Potential Tenant Foster Care Services PDF 12/10/2019
CFS-490 Non IV-E Medicaid Eligibility Redetermination Summary PDF 12/10/2019
CFS-495 - Instructions PDF 12/10/2019
Interstate Compact on the Placement of Children PDF 12/10/2019
CFS-6094 - ICPC Adoptive Home Study Check List PDF 12/10/2019
ICPC-100B - Interstate Compact Report on Child PDF 12/10/2019
Request for OST CHRIS Report PDF 12/10/2019
VSP PDF 12/10/2019
CFS-490-A Non IV-E Medicaid Eligibility Redetermination Summary Additional Information PDF 12/10/2019
Marshallese PUB-055 PDF 12/10/2019
CFS-369 Placement Progress Report PDF 12/10/2019
CFS-208-A Instructions PDF 12/10/2019
CFS-240-U1 Instructions PDF 12/10/2019
CFS-240-U1 Notice of Unsubstantiated Child Maltreatment Investigative Determination to Alleged UJO (Under 14) PDF 12/10/2019
CFS-001 - Referral for Transitional Services & Support PDF 12/10/2019
CFS-025 - Transitional Youth Services Budget EXCEL 12/10/2019
CFS-200 Instructions Protection Plan PDF 12/10/2019
CFS-204-A Spanish Notice of Child Maltreatment Allegation to Parents, Guardians and Foster Parents of an Alleged Offender PDF 12/10/2019
CFS-210-A Instructions - Notice of Child Maltreatment Allegation to MDT Coordinator PDF 12/10/2019
CFS-214-R Notice of Child Maltreatment Allegation to Employer, Volunteer Coordinator, Licensing or Registering Authority PDF 12/10/2019
CFS-221-T_Instructions PDF 12/10/2019
CFS-223-T3 Spanish Child Maltreatment True Investigative Determination Notice to Alleged Juvenile Offender (14-17) PDF 12/10/2019
CFS-224-T3 - Instructions PDF 12/10/2019
CFS-225-T2 Child Maltreatment True Investigative Determination Notice to Current Foster Parent of AV in Care PDF 12/10/2019
CFS-229-T - Instructions PDF 12/10/2019
CFS-232-T PH Instructions PDF 12/10/2019
CFS-232-T2 Marshallese True But Exempt Child Maltreatment Investigative Determination Notice to Offender PDF 12/10/2019
CFS-242-U Notice of Unsubstantiated Child Maltreatment Investigative Determination to Licensing or Registering Authority PDF 12/10/2019
CFS-245-U1 Notice of Unsubstantiated Child Maltreatment Investigative Determination to Alleged Victim PDF 12/10/2019
CFS-249-U - Instructions PDF 12/10/2019
CFS-261-O - Instructions PDF 12/10/2019
CFS-265-O2 Notice of Overturned True Child Maltreatment Inv Det to Current FP of Alleged Victim PDF 12/10/2019
CFS-510 Requirement to Attend Child Welfare Agency Review Board Meeting PDF 12/10/2019
CFS-275-O Instructions PDF 12/10/2019
CFS-284-N Spanish Notice of Name Placement on Central Registry to Parents and Legal Guardians of Juvenile Offender (14-17) PDF 12/10/2019
CFS-288-N - Instructions PDF 12/10/2019
CFS-291-N2 - Instructions PDF 12/10/2019
CFS-296-N Notice of Name Placement on Central Registry to Employer of Offender in a Designated Position w AR State Agency PDF 12/10/2019
CFS-302 - Interdivisional Staffing Summary Form DOC 12/10/2019
CFS-308 Child Fatality Review Packet Checklist PDF 12/10/2019
CFS-320 - Instructions PDF 12/10/2019
CFS-323-A Notice to Adult Relatives by Blood, Adoption or Marriage that a Child has been taken into DCFS Custody PDF 12/10/2019
CFS-326 Outcome of Complaint Review (Other than Child Maltreatment) PDF 12/10/2019
CFS-335 - Confirmation of Receipt of Goods for Youth in Foster Care PDF 12/10/2019
CFS-343 - Notification of Court Appearance PDF 12/10/2019
CFS-352 - Medical, Dental, Vision, Hearing & Psychological Episodic Form PDF 12/10/2019
CFS-362 - Instructions PDF 12/10/2019
CFS-368 Child’s Health Services Plan DOC 12/10/2019
CFS-384 Notification to Local Education Agency of Changes in Child Placement, Schools, or Traumatic Experiences PDF 12/10/2019
CFS-411 - Affidavit PDF 12/10/2019
CFS-425 - Application for Adoption Subsidy PDF 12/10/2019
CFS-428-C Adoption Assistance Agreement For Non-Recurring Adoption Expense Payment PDF 12/10/2019
CFS-433 -  Instructions PDF 12/10/2019
CFS-450 Instructions PDF 12/10/2019
CFS-457 - Instructions PDF 12/10/2019
CFS-471 Adoption Disclosure PDF 12/10/2019
CFS-475-D Transfer of Foster Home from Another County PDF 12/10/2019
CFS-486 - SSI Screening Questionnaire PDF 12/10/2019
CFS-490 - Instructions PDF 12/10/2019
CFS-496 - Assessment for Income Assistance PDF 12/10/2019
CFS-593 VSP Additional Requirements for DCFS Drivers PDF 12/10/2019
CFS-4330 - Child Welfare Student Stipend Agreement PDF 12/10/2019
CFS-6024 - Permanency Planning Court Report DOC 12/10/2019
CFS-6095 ICPC Case Manager Statement PDF 12/10/2019
Foster Parent ITNA PDF 12/10/2019
ICPC-100B - Instructions PDF 12/10/2019
CFS-015 Request for Service Encumbrance PDF 12/10/2019
CFS-240-U2 Marshallese Notice of Unsubstantiated Child Maltreatment Investigative Determination to Alleged Juvenile Offender (14-17) PDF 08/20/2013
Arkansas Department of Human Services
Arkansas Department of Human Services

Arkansas Department
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TTY: 1-800-285-1131 or dial 711 for Arkansas Relay Service

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