Forms - Numerical Index

DCF-136 - Report of Suspected Child Abuse or Neglect

Jump to form #'s:  1-449     550+     1000+     2000+    2100+    2200+     3000+     4100 + 

Form #'s:  1-549

DCF-Probate-003 – Report for the Probate Court for Temporary Custodian – 46-4-3
DCF-005 – Background Searches – 41-1
DCF-006 – Interim Licensing Action Requirements for a Foster Care Licensing Change – 41-1
DCF-008 – Emergency Home Assessment for Child Specific Placement – 41-1
DCF-009 – Foster Care Licensing Placement Waivers Request Form – 41-1
DCF-011 – Veterinary Statement – 41-1
DCF-013A – Assessment of Regulatory Compliance – 41-1
DCF-020 – Physician's Statement for Foster Care Application – 41-1
DCF-023 - Educational Statement for a Child of a Foster Care or Adoptive Applicant - 41-1
DCF-Probate-023 – Educational Statement for a Child of a Probate Court Custodian/Guardian Applicant – 46-4-3
DCF-030 – Pool Inspection – 41-1
DCF-043 – Verification of Requirements for Licensure – 41-1
DCF-047 – Application for Foster Care License – 41-1
DCF-048 – Request for Inspection of Well Water – 41-1
DCF-065 – Conditions of Parole Status – 22-9-3
DCF-066 – Juvenile Services - Expectations of Placement – 22-9-3
DCF-091 – Prospective Foster Family Budget Worksheet – 41-1
DCF-105 – One on One Mentoring Program Exception Form – 42-3
DCF-109 – Functional Family Therapy (FFT) Referral Form – 41-1
DCF-136 – Report of Suspected Child Abuse/Neglect – 33-1
DCF-159  – Immediate Removal/96-Hour Hold of Child(ren) – 34-10-4.1
DCF-159S – Immediate Removal/96-Hour Hold of Child(ren) (Español) – 34-10-4.1
DCF-160 – Immediate Removal/96-Hour Hold Placement Notification – 34-10-4.1
DCF-160S - Immediate Removal/96-Hour Hold Placement Notification (Español) – 34-10-4.1
DCF-334 – Adoption Resources Exchange (ARE) Family Registration – 41-40-3.4
DCF-335 – Withdrawal/Placement Notification – 41-40-3.1, 48-10-2
DCF-336 – Child's Registration (FORM IS LOCATED IN LINK ONLY) – 41-40-3.1, 48-7-3, 48-14-6.5
DCF-337 – Genetic Parent(s) Information (Use When Submitting to Superior Court) – 48-19-2
DCF-Probate-337 – Genetic Parent(s) Information - 46-4-6
DCF-338 – Medical Information on Genetic Parent (Use When Submitting to Superior Court) – 48-15-9, 48-19-2
DCF-Probate-338 – Medical Information on Genetic Parent(s) - 46-4-6
Attachment – Format for the Adoption Social Study – 48-19-2
DCF-354– Application for Foster Care or Adoption – 41-1
DCF-357 – Physician’s Statement for Foster Care or Adoptive Applicant – 41-1
DCF-Probate-357 – Physician's Statement for Voluntary Services/Probate Applicant – 46-4-8
DCF-374 – Eligibility Form – 16-3-2
DCF-378 – Individual Case Establishment – 48-18-6
DCF-379 – Case Establishment - Referral Form – 48-15-10
DCF-382 – Worker Change/Assignment Form – 48-18-6
DCF-383A – Authorization: Therapeutic One-to-One Safety Staffing – 48-18-6
DCF-383B – Billing Invoice: Therapeutic One-to-One Safety Staffing – 48-18-6
DCF-415 – Unified School District 2 Jurisdiction Certification – 45-3
DCF-416 – Certification of Special Needs Status – 48-18-6, 48-19-2, 41-40-10.3
DCF-418-A – Adoption Subsidy Agreement, Annual Agreement – 41-40-10.4, 48-18-12.2
DCF-418-AG – Annual Agreement for a Relative Guardianship Subsidy – 41-50-11
DCF-418-I  – Adoption Subsidy Agreement, Initial Agreement – 41-40-10.3, 48-18-6
DCF-418-IS – Adoption Subsidy Agreement, Initial Agreement (Español) – 41-40-10.3, 48-18-6
DCF-418-IG – Initial Agreement for a Relative Guardianship Subsidy – 41-50-8
DCF-419 – Commissioner's Statement of Support – 48-18-6, 48-19-2
DCF-419A – Commissioner's Statement of Support After Adoption Finalization – 41-40-10.3
DCF-420 – Adoption Report – 48-18-6
DCF-421  – Agreement for Placement Before Adoption – 48-15-9, 48-19-2
DCF-425A – Application to Renew a License for Foster Care or Adoption – 41-1
DCF-425B – Recommendation for License Renewal – 41-1
DCF-431 – Report of Non-Use of Adoptive Home – 41-40-4.1, 48-14-6.1
DCF-446 – Inspection of Auxiliary Heating Source – 41-1
DCF-449 – Permission to Place and Treat Child/Youth in Voluntary Services Program – 44-4-2, 37-4
DCF-460 – Informed Consent For Necessary Or Emergency Health Care – 26-1
DCF-460A – Permission To Deliver or Obtain Routine Health Care – 26-1
DCF-460MDE – Permission to Conduct a Multidisciplinary Evaluation and Release of Information – 26-1
DCF-460MDE-A – Multidisciplinary Evaluation Child/Youth Permission for Release of Information – 26-1
DCF-461 – Medical Screening for Placement – 26-1
DCF-462 – DCF Hospital Support and Visitation Plan – 26-1
DCF-465 – Psychotropic Medication Consent Requests – 26-1
DCF-465A – Discontinuation of a Psychotropic Medication – 26-1
DCF-465B – Suspected Adverse Drug Reaction Reporting Form – 26-1
DCF-465R – DCF Response to Medication Request – 26-1
DCF-469 – Child Placement Document – 36-50-2, 41-1
DCF-469A – Foster Homes Contacted by the Matcher – 41-1
DCF-470 – Resource Family Support Plan – 41-1
DCF-472 – Connecticut Family Assessment – 41-1
DCF-473 – Licensed Foster Homes Complaint Log – 41-1
DCF-526 – Request for Voluntary Placement – 36-50-5.2

Form #'s:  550-999

DCF-550 – Title IV-E XIX Application – 16-341-40-10.5, 41-50-7, 48-18-6
DCF-551 – Title IV-E Redetermination – 16-3
DCF-552 – Title IV-E Adoption Subsidy Application – 48-18-6
DCF-552A – Title IV-E/Title XIX Redetermination Form, Adoption Assistance – 48-18-12.2
DCF-553 – Administrative Case Review of Treatment Plan – 36-11-1
DCF-553F – Administrative Case Review of Family Treatment Plan – 36-11-1
DCF-554 – Administrative Case Review of Treatment Plan Follow-Up Letter to Parents – 36-11-1
DCF-603 (Form in LINK ONLY) – Notification to Local Education Agency of a Department PlacementThis form is located in LINK for DCF staff: View the DCF-603 Training Video Here, 45-4
DCF-604 – Notification Regarding Child's Continued Attendance in School of Origin – 45-12
DCF-632 – Financial Assistance Required for Post SecondaryEducation – 42-4
DCF-633 – Statement of Financial Assistance Post Secondary Education – 42-4
DCF-634 – Confirmation of Financial Assistance – 42-4
DCF-635 – Notification to Bookstore – 42-4
DCF-706 – Request for Approval to Accrue Compensatory Time DCF Exempt Personnel – 8-2
DCF-720 – Verification of Requirements for Approval/Re-Approval for Foster and Prospective Adoptive Families 41-1
DCF-722 – Physician's Statement for Day Care or Authorized Respite Care – 36-55-25.10, 41-1
DCF-724 – Social Information for Probate Court Proceedings – 48-21-5
DCF-736 – Notification to Department of Agriculture of Suspected Animal harm, Neglect or Cruel Treatment – 31-8-3.2
DCF-737 – Notification to State/Local Police of Suspected Child Sexual Abuse, Severe Physical Abuse and/or Neglect – 33-1
DCF-738 – Agreement for Reimbursement of Non-Recurring Adoption Expenses – 48-18-6, 48-19-2
DCF-738S – Agreement for Reimbursement of Non-Recurring Adoption Expenses (Español) – 48-18-6, 48-19-2
DCF-739 – Application for Reimbursement for Non-Recurring Adoption Expenses – 48-18-6, 48-19-2
DCF-739S – Application for Reimbursement for Non-Recurring Adoption Expenses (Español) – 48-18-6, 48-19-2
DCF-741 – Medical Alert – 36-50-2, 26-1
DCF-741HS – Health summary / Health Passport – 26-1
DCF-742 – Report of Health Care Visit – 26-1
DCF-742A – Instructions to Caregiver for Health Passport – 26-1
DCF-742B – Instructions to Health Providers for Health Passport – 26-1
DCF-745 – Multidisciplinary Evaluation Info Gathering Questionnaire – 26-1
DCF-746 – Multidisciplinary Evaluation Report – 26-1
DCF-747 – Multidisciplinary Summary and Recommendations – 26-1
DCF-761 – Landlord Notification – 41-1
DCF-763 – Respite Care Placement Request – 41-1
DCF-777 – Credit Report Letter to Child's Attorney – 42-1
DCF-778 – Credit Report Letter to State's Attorney – 42-1
DCF-779 – Notice at Age of Majority – 42-1
DCF-779S – Notice at Age of Majority (Español) – 42-1
DCF-779VS – Notice at Age of Majority - Voluntary Services Clients – 37-9
DCF-785 – Medical Review Board Referral – 26-1
DCF-786 – Medical Review Board Recommendation: Commissioner’s Decision – 26-1
DCF-787 – DMHAS Young Adult Services Program Referral
DCF-788 – DMHAS YAS Referral Checklist
DCF-800 – Notice of Proposed Denial, Suspension, Reduction, or Discontinuance of DCF Benefits – 22-4-3, 41-40-10.4, 41-50-1242-1
DCF-800A – Clients Agreement to Suspend, Reduce or Terminate DCF Benefits – 22-4-3, 41-40-10.4, 41-50-1242-1
DCF-800B – Letter of Withdrawal or Confirmation of Request for Administrative Hearing – 22-4-2
DCF-805 – Assessment for Licensure for a Relative, Special Study, or Independent (Interstate Compact) Home – 41-1
DCF-822 – Visitation Log – 36-50-2
DCF-823 – Critical Incident Summary/Update Form – 33-1
DCF-824 – Significant Event Report Form – 31-8-3
DCF-901 – Child and Family Teaming Summary Report – 36-8
DCF-906 - Report To Superior Court For Juvenile matters Regarding Child's Foster Home Placement, 46-3-4

Form #'s:  1000-1999

DCF-1011 – Motion for Determination Regarding Continuation in Care – 46-3-22
DCF-1090 – Application for Authorization to Provide Respite Care – 41-1
DCF-1091 – Initial Assessment for Authorization to Provide Respite care – 41-1
DCF-1091A – Acknowledgement Form – 41-1
DCF-1091B – Requirements for the Provision of Respite Care to Children with Complex Medical Needs – 41-1
DCF-1092 – Authorization to Provide Respite Care – 41-1
DCF-1094 – Assessment for Renewal of Authorization to Provide Respite Care – 41-1
DCF-1095 – Child Profile for Respite Care – 41-1
DCF-1248 – Safety Communication System for Deaf and hard of Hearing Parents and Caregivers
DCF-1999 – Affidavit Seeking Out-of-Home Placement of a Child – 46-3-13, 46-3-33

Form #'s:  2000 - 2099

DCF-2005 – Checklist for Filing Neglect Petitions – 46-3-10, 46-3-33
DCF-2010 – Motion for Order of Notice – 46-3-17, 46-3-33
DCF-2011 – Motion for Order of Certified Mail, Restricted Delivery – 46-3-17, 46-3-33
DCF-2012 – Checklist for Filing an Order of Temporary Custody with Neglect – 46-3-19, 46-3-33
DCF-2013 – Checklist for Filing Order of Temporary Custody When Neglect Petitions Were Previously Filed – 46-3-19.2, 46-3-33
DCF-2014C – Motion to Defer (Criminal) – 46-3-21.1
DCF-2014N – Motion to Defer (Neglect) – 46-3-21.1
DCF-2015 – Motion for Continuance – 46-3-21.1
DCF-2016 – Checklist for Filing Termination of Parental Rights – 46-3-21.1, 46-3-33
DCF-2018 – Checklist for Filing Motion to Review Plan for Child for Whom DCF is the Statutory Parent – 46-3-25
DCF-2020 – Checklist for filing Revocation of Committment Petitions – 46-3-33
DCF-2029 – Notification to Parent(s) Guardian Change of Visitation Schedule – 36-75-1
DCF-2029 S – Notification to Parent(s) Guardian Change of Visitation Schedule (Español) – 36-75-1
DCF-2030 – Notification of a Change in Placement – 36-50-5.3
DCF-2030s – Notification of a Change in Placement (Español) – 36-75-1
DCF-2033 – Report of Absences of Employees from Training Academy – 11-2, 31-4-15
DCF-2036 – Checklist for Filing Termination of Parental Rights in Probate Court – 48-8-2
DCF-2037 – Affidavit Regarding Diligent Search for Parent's Identity and Location – 46-3-18,46-3-33
DCF-2038 – Checklist for Recruitment Plan – 48-10-2
DCF-2039 – Child Assessment – 48-12-2, 48-14-6.5
DCF-2040 – Adoption Readiness Case Consultation – 48-12-4
DCF-2041 – Adoption Information Checklist for Foster Parent Adoption – 48-12-4
DCF-2042 – Permanency Planning Team Members – 48-14-6.5
DCF-2043 – Permanency Planning Team Referral Form – 48-14-6.5
DCF-2043G – Referral to Permanency Planning Team for Subsidized Relative Guardianship – 41-50-3
DCF-2044 – Child Teaming Pre-Questionnaire – 48-14-6.5
DCF-2045 – Permanency Planning Team Report – 48-14-6.5
DCF-2045G – Permanency Planning Team Report for Subsidized Relative Guardianship – 41-50-3
DCF-2046 – Status Report for Permanency Planning Team – 48-14-6.5
DCF-2047 – Team Presenters Evaluation Form – 48-14-6.5
DCF-2048 – Rating Sheet – 48-14-6.5
DCF-2048G – Rating Sheet for Subsidized Relative Guardianship – 41-50-3
DCF-2049 – Adoptive Home Fact Sheet – 48-14-6.5
DCF-2050 – Permanency Planning Team, Confidentiality Statement for Non-Department Participants – 48-14-6.5
DCF-2051 – Subsidized Adoption Face Sheet – 48-18-6
DCF-2051G – Face Sheet for Subsidized Guardianship Record – 41-50-10
DCF-2052 – Application for Subsidy (After Finalization) – 41-40-10.3
DCF-2053 – Transmittal of Adoption Packet – 48-19-2
DCF-2054 – Wednesday’s Child Recruitment Log – 41-40-5.2
DCF-2058 – Adoption Search Data Sheet – 41-40-7
DCF-2059 – Application for Post-Adoption Services – 48-20
DCF-2061 – Adoption Registration for Medical Information – 41-40-7
DCF-2063 – Specific Recruitment Inquiries – 41-40-5.1
DCF-2064 – Case File Notes – 41-40-7
DCF-2065 – Consent Form – 41-40-8
DCF-2068 – Closing Information – 41-40-7
DCF-2069 – Notification of a Placement Review Team Meeting – 45-6-2
DCF-2070 – Determination of a Placement Review Team – 45-6-2
DCF-2072(a) – Services to Prevent Out-of-Home Placement and to Facilitate Reunification – 36-30-1
DCF-2072(b) – Services Needed But Not Available – 34-1, 36-30-1
DCF-2078 – Permanency Planning Team Log – 48-14-6.5
DCF-2080 – Quarterly Voluntary Placement Report – 36-50-5.6
DCF-2081 – Affirmative Action Grievance Affidavit – 9-1
DCF-2082 – Notification to Foster Parent of Child's Planned Placement Change – 36-55-15
DCF-2084 – Adolescent Case Transfer Conference – 42-1
DCF-2085 – Authorization for Administrative Exception for Out-of-State Placement – 36-92
DCF-2086 – Determination of Reviewer – 45-6-2
DCF-2091 – Independent Living Case Plan – 42-1
DCF-2092 – Adolescent Transition Plan – 42-3
DCF-2093 – Community Meeting Documentation Form – 42-1
DCF-2095 – Application for Re-Entry to Adolescent Services Program – 42-8
DCF-2097 – Application for Financial Assistance For Post Secondary Education – 42-4, 48-20-2

Form #'s:  2100-2199

DCF-2101 – Certification of a Child’s Complex Medical Needs – 41-7-2
DCF-2101R – Certification of a Child’s Complex Medical Needs (Review for an Adoption Subsidy) – 41-40-10.4
DCF-2101S – Certification of a Child with Complex Medical Needs for Subsidized Adoptions and Subsidized Guardianships – 41-40-10.4
DCF-2102 – Discharge Plan for a Child with Complex Medical Needs – 41-7-6
DCF-2103 – Extraordinary Expenses-Care of a Child with Complex Medical Needs – 41-1
DCF-2104 – Classroom Observation of Academic and Behavioral Performance – 27-3-19
DCF-2105 – Initial Assessment Report Form – 27-3-19
DCF-2106 – PPSP Accounting Invoice – 48-22-2
DCF-2107 – Service Agreement, PPSP – 48-22-2
DCF-2109 – Authorization for Release of Information for Foster Care License – 41-1
DCF-2111 – Disciplinary Agreement – 41-1
DCF-2112 – Confidentiality Agreement – 41-1
DCF-2112S – Confidentiality Agreement (Español) – 41-1
DCF-2116 – Network/Security Change Request Form – 12-10-4
DCF-2124 – Title IX: Sex Discrimination Grievance Form – 27-3-27
DCF 2124A – Title IX Informal Resolution – 27-3-27
DCF-2125 – Authorization for Local Police Criminal Records Search – 41-1
DCF-2126  – Regional Resource Group Consultation Request – 38-2
DCF-2127 – Caretaker Log of Visits to Providers – 44-4-1
DCF-2131(F) – Authorization for Release of Information From DCF – 31-8-5, 34-1
DCF-2131(T) – Authorization for Release of Information To DCF – 31-8-5, 34-1
DCF-2131(F) (Arabic) – Authorization for Release of Information From DCF (Arabic) – 31-8-5, 34-1
DCF-2131(T) (Arabic) – Authorization for Release of Information To DCF (Arabic) – 31-8-5, 34-1
DCF-2131(F) (French) – Authorization for Release of Information From DCF (French) – 31-8-5, 34-1
DCF-2131(T) (French) – Authorization for Release of Information To DCF (French) – 31-8-5, 34-1
DCF-2131S(F) – Authorization for the Release of Information From DCF (Español) – 31-8-5, 34-1
DCF-2131S(T) – Authorization for Release of Information To DCF (Español) – 31-8-5, 34-1
DCF-2131(F) (Vietnamese) – Authorization for Release of Information From DCF (Vietnamese) – 31-8-5, 34-1
DCF-2131(T) (Vietnamese) – Authorization for Release of Information To DCF (Vietnamese) – 31-8-5, 34-1
DCF-2132 – Request for Surrogate Parent – 45-10
DCF-2139 – Ombudsman’s Office Contact Sheet – 2-4-1
DCF-2140 – Authorization for Out-of-State Travel for a Foster Child – 36-55-12
DCF-2141 – Domestic Violence Assessment – 34-3
DCF-2143 – Respite Care for Licensed Families – 41-1
DCF-2144 – Special Study Preliminary Assessment – 41-1
DCF-2147 – Medical Questionaire/Request for Information – 34-11
DCF-Probate-2147 – Medical Questionaire/Request for Information (Probate) – 46-4-3
DCF-2148 – Child and Adolescent Respite Services Referral Protocol – 39-21
DCF-2149 – Checklist for Filing Coterminous Petitions-Order of Temporary Custody and Neglect – 46-3-21.5, 46-3-33
DCF-2152 – Change of Worker or Parent’s Address – 46-3-33
DCF-2153 – Authorization for Private Facilities to Exceed DCF Licensed Bed Capacity – 20-8-8
DCF-2156 – Authorization for a Placement Which Exceeds Population Limitations – 41-1
DCF-2157 – Authorization Bed held – 41-1
DCF-2158 – Assessment of Child and Family for Relative Guardianship – 41-1
DCF-2159 – Application for a Relative Guardianship Subsidy – 41-50-4
DCF-2161 – Title VI and Section 504 Grievance Form – 27-3-28
DCF-2163 – Request for Case Management Services (CHAP/CHEER) – 42-5
DCF-2163A – Request for Case Management Services Non-Per Diem Provider – 42-1
DCF-2166A – Adolscent Services Service Agreement – 42-7
DCF-2167 – Permission to Participate in USD II Educational Field Trips and Program Activities – 27-3-12
DCF-2168 – Application for Consideration to the Institutional Review Board – 26-8-1
DCF-2169 – Assessment of Child and Family for Removal of Guardian & Temporary Custody – 46-4-2
DCF-2170 – Books, Supplementary Materials and Equipment Review – 27-3-20.1
DCF-2171 – USD 2 Lesson Plan – 27-3-20.2
DCF-2175 – Voluntary Services Program - Initial Information – 37-2
DCF-2177 – Voluntary Service Program Application for Services – 37-4
DCF-2178 – Notice of Acceptance (Voluntary Services) – 37-4
DCF-2179 – Withdrawal of Application (Voluntary Services) – 37-9
DCF-2180 – Safety Plan – 34-10-1
DCF-2190 – Therapeutic Child Care Gatekeeper Form

Form #'s:  2200 - 2999

DCF-2210 – Notification of Investigation Results – 34-12-8
DCF-2210-(AR) – Notification of Investigation Results (Arabic) – 34-12-8
DCF-2210-(FR) – Notification of Investigation Results (French) – 34-12-8
DCF-2210-(FR-CA) – Notification of Investigation Results (French-Canadian) – 34-12-8
DCF-2210-(HC) – Notification of Investigation Results (Haitian-Creole) – 34-12-8
DCF-2210-(S) – Notification of Investigation Results (Español) – 34-12-8
DCF-2210-B – Request for Appeal of Substantiation Finding(s)/Recommendation for Placement on Central Registry – 34-12-8
DCF-2210-B(AR) – Request for Appeal of Substantiation Finding(s)/Recommendation for Placement on Central Registry (Arabic) – 34-12-8
DCF-2210-B(FR) – Request for Appeal of Substantiation Finding(s)/Recommendation for Placement on Central Registry (French) – 34-12-8
DCF-2210-B(FR-CA) – Request for Appeal of Substantiation Finding(s)/Recommendation for Placement on Central Registry (French-Canadian) –  34-12-8
DCF-2210-B(HC) – Request for Appeal of Substantiation Finding(s)/Recommendation for Placement on Central Registry (Haitian-Creole) – 34-12-8
DCF-2210-B(SP)  – Request for Appeal of Substantiation Finding(s)/Recommendation for Placement on Central Registry (Español) – 34-12-8
DCF-2210-C – Notification of Investigation Results (Non-Perpetrator Parent or Guardian) – 34-12-8
DCF-2210-C(AR) – Notification of Investigation Results (Non-Perpetrator Parent or Guardian) (Arabic) – 34-12-8
DCF-2210-C(FR) – Notification of Investigation Results (Non-Perpetrator Parent or Guardian) (French) – 34-12-8
DCF-2210-C(FR-CA) – Notification of Investigation Results (Non-Perpetrator Parent or Guardian) French-Canadian) – 34-12-8
DCF-2210-C(HC) – Notification of Investigation Results (Non-Perpetrator Parent or Guardian) (Haitian-Creole) – 34-12-8
DCF-2210-C(SP) – Notification of Investigation Results (Non-Perpetrator Parent or Guardian) (Español) – 34-12-8
DCF-2212-A – Notification of Investigation Review Results – 34-12-8
DCF-2212-B – Notification of Investigation Review Results – 34-12-8
DCF-2212-CMS – Notification of Internal Review Results (CMS) – 34-12-8
DCF-2213 – Deferral of Review of Investigation Results – 34-12-8
DCF-2214 – Denial of Review of Investigation Results – 34-12-8
DCF-2220 – Closing Checklist - Treatment – 36-110-1.1
DCF-2223 – Certification of Title IV-E Status – 47-3-7
DCF-2224 – Interstate Compact Financial and Medical Plan – 47-3-7
DCF-2225 – Interstate Compact Progress Report – 47-3-7
DCF-2226 – Interstate Compact Referral Checklist – 47-3-7
DCF-2227 – Social Work Statement of Potential Placement (ICPC) – 47-3-7
DCF-2231 – Spending Plan for Flexible Funding for Client Services – 36-102
DCF-2232 – Request for Client Services, Non-Contracted Flexible Funding – 36-102
DCF-2233 – Waiver of Requirements for Licensure of Foster/Adoptive Families Pending FBI Clearance – 41-1
DCF-2235 – Reminder Letter – 41-1
DCF-2236 – Notice of Privacy Practices – 44-7-4
DCF-2236 (Arabic) – Notice of Privacy Practices (Arabic) – 44-7-4
DCF-2236 (French) – Notice of Privacy Practices (French) – 44-7-4
DCF-2236 S – Notice of Privacy Practices - Spanish – 44-7-4
DCF-2236 (Vietnamese) – Notice of Privacy Practices - Vietnamese – 44-7-4
DCF-2237 – Restriction on Use/Disclosure of Protected Health Information – 44-7-5
DCF-2238 – Use/Disclosure Complaint – 44-7-10
DCF-2240 – Motion to Review Permanency Plan/Maintain Commitment/Revoke Commitment/Transfer Guardianship – 46-3-22, 46-3-33
Attachment – Format for Study in Support of Permanency Plan To Revoke Commitment or Transfer Guardianship – 46-3-22.1
DCF-2245 – Checklist for Diligent Search – 46-3-18, 46-3-33
DCF-2246 – Checklist for Filing a Motion to Review Permanency Plan/FWSN – 46-3-22, 46-3-33
DCF-2247 – Checklist for Filing a Motion to Review Permanency Plan/Maintain Commitment/Revoke Commitment/Transfer of Guardianship – 46-3-22, 46-3-33
DCF-2248S – Adoption Placement-Child Disclosure Form (Español) – 48-15-5
DCF-2248 – Adoption Placement-Child Disclosure Form – 48-15-5
DCF-2251 – Commuinity Housing Assistance Program (CHAP) Contract – 42-3
DCF-2252 – Community Housing Employment Enrichment Resources (CHEER) Contract – 42-5
DCF-2257 – Authorization: One-to-one Staff – 39-2
DCF-2258 – Billing Invoice: One-to-one Staff – 39-2
DCF-2260 – Authorization for release of photos and videos
DCF-2260S – Authorization for release of photos and videos (Español)
DCF-2261 – Substance Use Managed Service System Case Presentation Form – 38-2
DCF-2262 – Substance Use Managed Service System Confidentiality Agreement – 38-2
DCF-2263 – Substance Use Managed Service System Release of Information – 38-2
DCF-2263S – Substance Use Managed Service System Release of Information (Español) – 38-2
DCF-2264 – Project SAFE Substance Use Referral Questions – 38-2

Form #'s:  3000 - 3999

DCF-3000 – Community Based Life Skills Program - Annual Report
DCF-3001 – Community Based Life Skills Program - Referral Form
DCF-3002 – One on One Mentoring Program - Annual Report
DCF-3005 – Letter to Relatives of Children Taken into DCF Care – 46-3-22
DCF-3006 – Letter to Parents Requesting Relative Information – 46-3-22
DCF-3007 – Services Available to Relative Caregivers – 46-3-22
DCF-3008 – Report of Secure Transport – 46-3-22
DCF-3009 – Notification of Court to Out of Town Placement – 46-3-22
DCF-3010 – Unique Service Expenditure Application (USE) – 31-8-6
DCF-3011G – Family Protective Factors Guide – 46-3-22
DCF-3011WS – Family Protective Factors Worksheet – 46-3-22
DCF-3012 – Application for Approval: Prevention and Emergency Safety Intervention Training Program
DCF-3013 – Attachment A (Appointment of Health Care Representative) – 36-5, 42-1
DCF-3014 – Attachment B (Living Will) – 36-5, 42-1
DCF-3015 – Unique Service Expenditure Review (USE) – 31-8-6
DCF-3016 – Unique Service Expenditure Waiver Request – 31-8-6
DCF-3017 – Acceptable Use of LexisNexis System (USE) – 41-16-2.2
DCF-3018 – Notice of Liability – 37-4, 37-4-1
DCF-3019 – Intake-Voluntary Services Initial Request (Only to be utilized by Careline staff) – 37-4
DCF-3020 – Instructions for Completion of Notice of Liability (DCF-3018) and Financial Assessment of Legally Liable Relative – 37-4-1
DCF-3021 – Preferred Elements: Prevention and Emergency Safety Intervention Training Program – 31-12-12.4
DCF-3022 – Required Elements: Prevention and Emergency Safety Intervention Training Program – 31-12-12.4
DCF-3023 – Application for Approval: Prevention & Emergency Safety Intervention Training Program – 31-12-12.4
DCF-3025 – Notification of Family Assessment Response Results
DCF-3027 – Photo ID Replacement Request – 17-1
DCF-3028 – DCF/DDS Voluntary Services Program Transfer/Closing Summary
DCF-3029 / DCF-3029 H – Notice of Denial of Voluntary Services and Hearing Request – 37-4, 37-4-1
DCF-3030 – Notification to Foster Parent of Court Hearing – 46-3-24.1
DCF-3030S – Notification to Foster Parent of Court Hearing (Español) – 46-3-24.1
DCF-3031 – Authorization for Release of Information for DCF CPS Search (This form is for: Employment, Day Care, Volunteers, Interns and Mentors)
DCF-3032 – Athorization for Release of Information for DCF CPS Search
DCF-3033 – Foster Care and Adoption Background Search Release (This form is for prospective foster and adoptive parents only)
DCF-3034 – Field Visit Reporting Form – 20-2
DCF-3035 – Considered Removal Child and Family Team Meeting – 34-10-1
DCF-3036 – Considered Removal CFTM Summary Report – 34-10-1
DCF-3037 – Considered Removal Sign In Sheet For Meeting Participants – 34-10-1
DCF-3038 – Considered Removal Participants and Concerted Efforts – 34-10-1
DCF-3040 – Child and Family Permanency Teaming Sign-In Sheet for Meeting Participants – 36-8
DCF-3050 – Secondary Employment Request
DCF-3060 – Adult Adoptee Request for Information – 41-40-7,41-40-8
DCF-3061 – Contact Preference and Reunion Registry Form for Genetic Parents – 41-40-7,41-40-8
DCF-3062 – Request for Adoption Search – 41-40-7,41-40-8
DCF-3107 – Acceptable Use of LexisNexis System – 41-1
DCF-3125 – Grant Development Approval Protocol (FOR DCF STAFF ONLY)

Form #'s:  4100+

DCF-4100 – Extended Day Treatment Referral form
DCF-4101 – Supervision Session Agenda – 7-22
DCF-4200 – Data Use Agreement
DCF-4928 – Foster Family Profile – 41-1
DCF-8101 – Sexual Assault Brochure – 81-3-5
DCF-8101S – INFORMACIÓN SOBRE ASALTO SEXUAL – 81-3-5
DCF-8102 – CJTS PREA Brochure Acknowledgement – 81-3-5
DCF-8103 – Rape & Sexual Assault Information & Resources – 81-3-5
DCF-8103S – Violación y Asalto Sexual Información y Recursos – 81-3-5
DCF-8104 – CJTS PREA Handbook Acknowledgement – 81-3-5
DCF-8105 – CJTS PREA Employee Training – 81-3-5
DCF-8106 – CJTS PREA Acknowledgement Statement – 81-3-5
DCF-8107 – CJTS PREA-Compliant Screening for Assaultive and Sexually Aggressive Behavior and Risk for Sexual Victimization – 81-3-5
DCF-8108 – PREA Incident Report – 81-3-5

Additional DCF Forms

FMLA-HR1 – FMLA Employee Request
FMLA Guidelines – Understanding Family and Medical leave
DCF-MA1 – Medical Assistance Form – 41-50-5.2
M2T – Notification of Change Form – 41-50-5.2
P33A – FMLA - Employee Medical Certificate
P33B – FMLA - Caregiver Medical Certificate
W1Y – HUSKY Application – 41-50-5.2
W-1HUSHUSKY APPLICATION and RENEWAL Form41-50-5.2
USD-187 – USD 2 Comprehensive Health Education Exclusion Request Form

Additional State Agency forms:

DAS Human Resources
Department of Developmental Services (DDS)
Interstate Compact
Judicial Department
Superior Court for Juvenile Matters
Workers Compensation

Non-DCF Forms

30-C – Workers Compensation of Connecticut Form for Notice of Claim for Compensation
CO-1317 – CT HEP Physical Notification Form
DCF-MA1 – Medical Assistance Form
FD-258 – Finger Print Card
PER WC-207 – Report of Occupational Injury or Disease to an Employee
PER WC-207-1 – Supervisor's Accident Investigation Report
W-1621 – Guarantee of Reimbursement
W-1685 – Medical Insurance Information
WCC-1A – Filing Status and Exemption Form

Interstate Compact Forms

ICAMA 6.01 – Notice of Medicaid Eligibility/Case Activation – 47-6-1
ICAMA 6.03 – Report of Change in Child/Family Status – 47-6-1
ICJ – Home Evaluation Report – 47-4-4
ICJ – Out of State Travel Permit and Agreement to Return – 47-4-4
ICJ – Quarterly Progress Report – 47-4-4
ICJ-1A-VI – Application for Compact Services – 47-4-4
ICJ-A – Petition for Requisition to Return a Runaway Juvenile – 47-4-4
ICJ-I – Requisition for Runaway Juvenile, Child Removed from Jurisdiction of Court – 47-4-4
ICJ-II – Requisition for Escapee Absconder – 47-4-4
ICJ-III – Requisition for Juvenile Charged with Being Delinquent – 47-4-4
ICJ – Consent for Voluntary Return by Runaway, Escapee or Absconder – 33-14-1, 47-4-4
ICJ-IV – Parole or Probation Investigation Request – 47-4-4
ICJ-V – Report of Sending State Upon Parolee or Probationer Being Sent to the Receiving State – 47-4-4
ICPC 102 – Receiving State's Priority Home Study – 47-3-7
ICPC 101 – Sending State Priority Home Study Request – 47-3-7
ICPC 100A – Interstate Compact Placement Request (and instructions) – 47-3-7
ICPC 100B – Interstate Compact Report on Child's Placement Status (and instructions) – 47-3-7

Juvenile Court Forms

JD-CL-140 – Firearm Safety Warrants
JD-FM-142 – Restraining Orders: How to Apply from Relief from Abuse|
JD-JM-30 – Custody Affidavit
JD-JM-31 – Order, Termination of Parental Rights and Appointment of Statutory Parent/Guardian
JD-JM-31A – Order, Cotermination of Parental Rights and Appointment of Statutory Parent/Guardian
JD-JM-40 – Petition for Termination of Parental Rights
JD-JM-58 – Motion/Order of Temporary Custody/Order to Appear
JD-JM-58A – Notice/Order of Temporary Custody/Order to Appear
JD-JM-60 – Affidavit/Consent to Termination of Parental Rights
JD-JM-61 – Order of Notice
JD-JM-61A – Notice to Unidentified Person
JD-JM-65 – Adjudicatory/Dispositional Orders
JD-JM-76 – Revocation of Commitment/Guardianship custody/Temporary custody/Subsequent Order of Custody/Temporary Custody Guardianship/Protective Supervision
JD-JM-98 – Petition: Neglected, Uncared-For, Dependent Child/Youth
JD-JM-106 – Specific Steps
JD-JM-106S – Pasos Specíficos (Español)
JD-JM-120 – Non School Complaint, Family With Service Needs
JD-JM-120A – Family With Service Needs - Parental Notice
JD-JM-129 – Permanency Plan Order and Review
JD-JM-149 – Order of Temporary Custody