ࡱ> '` B~bjbj{P{P *::Q (  $$$8"qlqD <hN$&&<&<&<&'D[','s9%<%<%<%<%<%<$`>h@I<i (''((I< <&<&<,,,(X <& <&s9,(s9,,:1, U2<&r ߕAV$(d1 G3,<0<2RA?)AU2A c2'"','''''I<I<A+'''<(((( $$ $  CASEWORKERS PERMANENCY PLANNING CHECKLIST(For Permanent Wards MCI or Court)State of MichiganDepartment of Human ServicesThis form will assist the caseworker in determining whether the childs current placement would be an appropriate home for adoption or guardianship. Complete a separate form for each child. The form must be signed by the caseworker and the caseworkers supervisor.Do not complete this form if adoption is the permanency goal on the service plan.Childs NameBirthdateCaseworker s Name FORMTEXT       FORMTEXT       FORMTEXT      Child s SWSS Log NumberCaseworker s Title FORMTEXT       FORMTEXT      Caregiver NameChild Placing Agency FORMTEXT       FORMTEXT      Caregiver AddressDate Completed FORMTEXT       FORMTEXT   / FORMTEXT   / FORMTEXT     IMPORTANT INFORMATION ABOUT GUARDIANSHIP ASSISTANCEFor a PCW or MCI ward to be eligible for guardianship assistance, the following apply:Child has resided with the prospective guardian for six or more consecutive months.Child demonstrates a strong attachment to the prospective guardian.Child 14 or older has been consulted about guardianship.Child is under 18 years of age.Adoption as a permanency goal has been ruled out.Placement with the guardian is in the childs best interest.A caregiver who meets all of the following criteria is eligible to receive financial assistance.Child was placed in the caregivers home by the department as a foster care placement.The caregiver is a licensed foster parent and all adult household members have successfully completed a criminal history check and child abuse registry check.The child is residing with the caregiver in the caregivers licensed foster home.The guardian has a strong commitment to caring permanently for the child.The DSH-3310, Guardianship Assistance Certification/Agreement Request must be completed for all prospective guardianship cases, unless the guardian is not requesting financial assistance.COMPLETE THE FOLLOWING QUESTIONNAIRE:YESNOa.The relative caregiver or non-relative caregiver is licensed (unless guardianship assistance is not requested). FORMCHECKBOX  FORMCHECKBOX b.The caregiver demonstrates that he/she possesses the capability to assume the role of primary caregiver. FORMCHECKBOX  FORMCHECKBOX c.The caregiver demonstrates the capability to work cooperatively with schools and other agencies to address the childs academic and other needs. FORMCHECKBOX  FORMCHECKBOX d.The caregiver demonstrates the capability to access appropriate medical care for the child. FORMCHECKBOX  FORMCHECKBOX e.The caregiver demonstrates the ability to manage visitation with birth parents or family members, if appropriate, so as to ensure that the child is not subject to harm or mistreatment. FORMCHECKBOX  FORMCHECKBOX f.The caregiver provides a safe and stable home environment that poses no danger to the child. FORMCHECKBOX  FORMCHECKBOX g.The caregiver demonstrates the ability to manage family issues such as illness and child rearing concerns. FORMCHECKBOX  FORMCHECKBOX h.The caregiver demonstrates the ability to meet the special needs of the child. FORMCHECKBOX  FORMCHECKBOX i.The child appears well integrated into the family. FORMCHECKBOX  FORMCHECKBOX  PERMANENCY PLANNINGIf the caseworker answers yes to all of the preceding questions, adoption or guardianship should be explored with the caregiver. If adoption is not the appropriate permanency goal for the child, explain why: FORMTEXT      The caseworker should discuss the options with the caregiver using the Caregiver Permanency Planning Checklist and Making the Decision to Become a Childs Permanent Family (DHS-Pub-140). This discussion and the answers on the checklist will help the caseworker determine whether the caregiver is interested in pursuing adoption or guardianship for the child(ren) in their care. The Caregiver Permanency Planning Checklist is to be used as documentation of the planning process. It is also important to discuss current and planned living arrangements even with young children. If the child is 14 years or older, the law requires that they have been consulted about adoption or guardianship. The permanency goal should not be pursued for the child until the childs questions or issues have been addressed by the caseworker or through counseling. If there is a question about the youths decision, the caseworker should also schedule a separate meeting to discuss the permanency options with the child. A youth age 14 or older is required to sign the Youths Statement located at the end of the Caregiver Permanency Planning Checklist. Caseworkers are encouraged to have all children of appropriate age involved in the discussion and allowed to sign the agreement. If any of the answers to the questions listed on page 1 are no and the caseworker does not believe that adoption or guardianship is appropriate, a conference should be held between the caseworker and supervisor to determine if it is in the childs best interest to remain in the current placement. The focus must be to develop a permanency plan that will ensure permanent supports and connections for the child. 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If you need help with reading, writing, hearing, etc., under the Americans with Disabilities Act, you are invited to make your needs known to a DHS office in your area.     DHS-2052 (Rev. 4-09) Previous edition obsolete. 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" (08@HPX`hpx &((0*X&(&&((&P$x&$$&$@&h&(N$0$X&&*$"(0PT$$(H hx <468H6864(6`846 4@ 2x 2 4 2 4X : : 2 H ` & 4 6 8 6P 8 6 4 60 8h 4 6 42H2424(:`: "0284p2420P2402 0X..0.0H6x6 ":>PB>F2`:>66P.2::02p62BF` 4 2 & (@ *h .  2 4 X ` p ]x]]]]]]] ]8]P]h]]]]]]]](]@DEFINE DIALOG BOXF,MyInfo DB@Fm ^YourName DB@Hm8^ YourTitle DB@HmP^ YourOffice DB@Hmi^ YourAddress DB@H2xYourCity DB@HT( YourState DB@HFYourZip DB@Hn(AreaCode DB@HP YourPhone DB@H<YourExt DB@Hr(FAXAC DB@HPYourFax DB@H(YourCO DB@H(YourDI DB@H(YourSEC DB@HT(YourUN DB@H(YourWKR DB@Hm^BossName DB@Hm^ BossTitle DB@Hk  /Enter the following information about yourself. DB@d#2 Name: DB@d;2 Title: DB@dR< Office: DB@dkU Address: DB@d City-ST-Zip: DB@d7 Phone: DB@d>% FAX: DB@dCO-DI-SEC-UN-WKR: DB@dK 6Enter the following information about your supervisor. 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MYINFO.ini DB@tUserInfoPhone P!\ MYINFO.ini DB@tUserInfoYourExt P!& MYINFO.ini DB@tUserInfoFaxAC P!( MYINFO.ini DB@tUserInfoFax P!* MYINFO.ini DB@tUserInfoOffice P!^ MYINFO.ini DB@tUserInfoAddress P!` MYINFO.ini DB@tUserInfoCity P!b MYINFO.ini DB@tUserInfoState P!d MYINFO.ini DB@tUserInfoZip P!f MYINFO.ini DB@tUserInfoCO P!h MYINFO.ini DB@tUserInfoDI P!j MYINFO.ini DB@tUserInfoSEC P!l MYINFO.ini DB@tUserInfoUN P!n MYINFO.ini DB@tUserInfoWKR P!p MYINFO.ini DB@tUserInfo Boss Name P!@ MYINFO.ini DB@tUserInfo Boss Title P!B MYINFO.ini DB@tGet user info from INI fileUserInfoName MYINFO.ini D%X' UserInfoTitle MYINFO.ini D%X' UserInfoAreaCode MYINFO.ini D%X' "UserInfoPhone MYINFO.ini D%X' $UserInfoYourExt MYINFO.ini D%X' &UserInfoFaxAC MYINFO.ini D%X' (UserInfoFax MYINFO.ini D%X' *UserInfoOffice MYINFO.ini D%X' ,UserInfoAddress MYINFO.ini D%X' .UserInfoCity MYINFO.ini D%X' 0UserInfoState MYINFO.ini D%X' 2UserInfoZip MYINFO.ini D%X' 4UserInfoCO MYINFO.ini D%X' 6UserInfoDI MYINFO.ini D%X' 8UserInfoSEC MYINFO.ini D%X' :UserInfoUN MYINFO.ini D%X' <UserInfoWKR MYINFO.ini D%X' >UserInfo Boss Name MYINFO.ini D%X' @UserInfo Boss Title MYINFO.ini D%X' B Update Form with user info WorkerName D%vG workerName  DB@xj WorkerTitle D%vG WorkerTitle  DB@xjWorkerAreaCode D%vGWorkerAreaCode " DB@xj WorkerPhone D%vG WorkerPhone $ DB@xjWorkerExtension D%vGWorkerExtension & DB@xjFaxAC D%vGFaxAC ( DB@xj WorkerFax D%vG WorkerFax * DB@xj Countynumber D%vG Countynumber 6 DB@xjDistrict D%vGDIstrict 8 DB@xjSection D%vGSECtion : DB@xjUnit D%vGUNit < DB@xjWorker D%vGWorker > DB@xj CountyName D%vG CountyName , DB@xj CoAddress D%vG CoAddress . DB@xjCoCity D%vGCoCity 0 DB@xjCoState D%vGCoState 2 DB@xjCoZip D%vGCoZip 4 DB@xjSupervisorName D%vGSupervisorName @ DB@xjSupervisorTitle D%vGSupervisorTitle B DB@xj. Update other Form Fields on Form & Exit Macro- Selected$=GetFormResult$ ("CurrentDate")! TheSerialDate = Today() + 14$ TheDate$ = Date$(TheSerialDate)& SetFormResult "DueDate", TheDate$) EditGoTo "CreateDate" : UnlinkFields EditGoTo "GranteefirstName"- ToolsProtectDocument .NoReset = 1, .Type = 2/ ToolsProtectSection .Section = 2, .Protect = 0d FileClose 2 SelectName = - 1kpoh`(Attribute VB_Name = "MyInfo" Public Sub Main(X) D.nDescription|Enter Personal rma:zProcDataIInvoke _FuncINoi8l..nADim iRet B  User$ATitleAreaCod-PhonYourExtFax|AC Offic $AddressCitByStat Zip ODILSEB;UN WKRBoss|| 'DEFINE DIALOG BOX WordBasic.BeginDialog 582, 300,} G TextBox 109@ A 5@ 18@ I @ey 56 * 83 _[ 105WDi 2A3321A5r 34 _  | 9 7 @ 1$55E [1 Pi 23` 6i`cV3jFAXAC41e lV1@,CO629 *DI7m pV? UN6z4!l1.yVm23n`~64`'Fz7,, c3z#the followin`g infa@bout ys0elf. ", ׂ !:w5f"bC #1z0@8O$351{1A-ST- u5 abm3r13@? gY  ;"C O-DI-T-U,N-@H47224*; supervisor!a 124f6p6iOKButtY48 8pR21 fCanctel3kEndn ҂dlg!u! As Object: Se$t = CurValues. vGET USER INFO FROMI FILE AND@ PUT I NTOzx.t[GetPrivfileS@@ng$](" "'P:qMY.ini"r hl ? pa"4??>? Mpn_1r &.nAC `axU/-Y??>OMA\C$$a&gp Op | DIpp/-UN0 | {p y QaserInfo", "Boss Name`MYINFO.ini") dlgU.Title = WordBasic.[GetPrivateProfileString$]("t| 'DISPLAY DIALOG BOX AND RESPOTO USER INPUT iRet Dialog.p (If 3-1 Then 'OK BUTTON ?WRI@TE NEW3FO6I FILE xSx wYour ?, - -AreaCod|PhonEExtE@FaxACL+@OfficZ|Address0$ L+gCity ? : |StP  z Zo%  CoCity  ! CoStat$c b CoZip  "Supervi8sor<`, Boss! /Titl% b ' Upd. other  FieldsH on& t Macro Rem" SelA}ed$=G$ ("Curre8ntD9'`Serial = Today() + 14$5()lDure",a"GEditGoTo 0"Cre : Unlink'Grante@efirst3"ToolsProtDocum! .No@et`1, .Type@2/ .8= 2 `0 Else#FileClose D c.@- 1$nd #Sub MEP(L6 LLLL@ ~`k xXnt%|%@Ph8@t @p @` @0P @L @H  @DO ( @H4 @`$ @x @ @ @ @ @ @ @  @8 @P @ht @d @T @D @4 @$ @ @ @ @ h`AB?$*\Rffff*0=4b2c99fd*\R1*#10b*\R1*#17b*\R1*#c1*\R1*#c6*\R1*#91*\R1*#166*\R1*#d4"  .*@)Pp &x /W ( *(5(P X h]@'If document is protected, Unprotect it.e ! cladd87 B@cenkPerform Spelling/Grammar check.d (er  !ws !(V !B@si  ReProtect the document. ! cladd87 l B@koAttribute VB_Name = "Module1" Sub FormsSpellCheck2() Dim x As wdNo Then  9ZPassword:="c@ladd87E nd If'P(erf ing/Gramma8r clK.Op2tBs.vWi thFalse EachIn JsZx.Range.iof>$;;5AlwaysSuggest :=Tru; Next: 'Re the=&EW, n orese&, o:=wdAllowOnlyAbAAeK*srU~~~~~~~~~i :[ Jʝ^ᑇ   a Q1 TemplateProject ThisDocumentMyInfoModule1F 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Office Word Document MSWordDocWord.Document.89q'` Bbjbj{P{P *::A$A$fffffffZp"q"qlqDfy}hrdBvBvBvBvBv.pz{|||||||$~hI}-f|BvBv||}ffBvBv3}||||fBvfBv||||||ffkt|Bvr ߕAVf||| I}0y}|I|I|If|||||||||}}||||y}||||fff$ffffffffffffff  FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT     FORMTEXT        FORMTEXT        FORMTEXT      FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT     FORMTEXT        FORMTEXT        FORMTEXT     FORMTEXT        FORMTEXT        FORMTEXT     FORMTEXT        FORMTEXT      FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEBLNPRfhvxzƌȌʌތ(*8:<PRTZ\^`tvj3hYqUjS3hYqUj2hYqUj1hYqUj1hYqUjq0hYqUj/hYqUjB/hYqUj|.hYqUhYqjhYqUjhYqUmHnHu3PxȌ:^֍ Hj܎(PxȏTSRQPOkNMLKJIHGFEDCBA@?>čƍԍ֍؍ "68FHJ^`bfhjlЎҎԎ؎ynyj9hYqUjhYqUmHnHuj_8hYqUj7hYqUjhYq5UmHnHuj6hYq5U hYq5jhYq5Ujs6hYqUj5hYqUj5hYqUjhYqUju4hYqUhYq+؎ڎ܎ގ$&(*>@NPRfhvxzƏȏʏޏ ~j>hYqUUj>hYqUj0=hYqUjO<hYqUj;hYqUj:hYqUjhYqUmHnHuj?:hYqUjUmHnHuj9U jUhYqjhYqU1XT        FORMTEXT        FORMTEXT        FORMTEXT     FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT     FORMTEXT      FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT     FORMTEXT     FORMTEXT      FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT       @hژ*Lp ,PxȚ@Bjihgfedcba`_^]\[ZYXWVU.0>@BVXfhj~Șʘؘژܘ(*,@BDHJLNbdflnprj6DhYqUjhYqUmHnHujChYqUjChYqUjBhYqUjAhYqUj?AhYqUj@hYqUj@hYqUjY?hYqUjhYqUhYq3r™ؙ֙ "$(*,.BDFLNPRfhvxzƚȚʚjIhYqUjIhYqUjHhYqUjAHhYqUjGhYqUjhYqUmHnHujFhYqUj\FhYqUjEhYqUjhYqUjDhYqUhYq3ʚޚ.02<>BjLhYqUj]KhYqUjhYqUmHnHujhYqUjJhYqUhYq(/ =!"#$% Bureau#Enter your Bureau/Office/Unit name.DCareOf UppercaseUEnter the Addressee's Supplemental Address (Example: Suite or Apartment Number, C/O)Address1D CaseNumber Uppercase/Enter the Case Number (Example: V1234567A,B,C)D ClientCity UppercaseEnter the Addressee's City. ClientStateD ClientState Uppercase1Enter the Addressee's 2 digit State Abbreviation. ClientZipD ClientZip UppercaseKEnter the Addressee's Zip Code (+4 if known) (Example: 48909 or 48909-7537)D CoAddress UppercaseaEnter the County's mail address (street address, PO Box, etc., where the mail will be delivered).D CoAreaCodeEnter the County's Area CodeDCoCity UppercaseEnter the County's City.D CoExtensiond8(OJQJ_HmH sH tH XOX CaseNumber1?d8(OJQJ_HmH sH tH XOX ClientCity1@d8(OJQJ_HmH sH tH ZOZ ClientState1Ad8(OJQJ_HmH sH tH ZO"Z ClientZip1BdtCJOJQJ_HmH sH tH VO2V CoAddress1Cd8(OJQJ_HmH sH tH XOBX CoAreaCode1 Dd`CJOJQJ_HmH sH tH PORP CoCity1Ed8(OJQJ_HmH sH tH ZObZ CoExtension1Fd8(OJQJ_HmH sH tH ^Or^ CoPhoneNumber1Gd8(OJQJ_HmH sH tH ROR CoState1Hd8(OJQJ_HmH sH tH ^O^ CoSuppaddress1Id8(OJQJ_HmH sH tH XOX CountyName1Jd8(OJQJ_HmH sH tH \O\ CountyNumber1 Kd`CJOJQJ_HmH sH tH ROR CoZip1LdtCJOJQJ_HmH sH tH NON Date11 Md`CJOJQJ_HmH sH tH TOT District2 Nd`CJOJQJ_HmH sH tH LOL FaxAC Od`CJOJQJ_HmH sH tH VOV FirstName1Pd8(OJQJ_HmH sH tH XOX FirstName21Qd8(OJQJ_HmH sH tH `O"` GranteeAddress1 Rd`CJOJQJ_HmH sH tH \O2\ GranteeCareof Sd`CJOJQJ_HmH sH tH XOBX GranteeCity Td`CJOJQJ_HmH sH tH `OR` GranteeClientID Ud`CJOJQJ_HmH sH tH dObd GranteeFirstName2 Vd`CJOJQJ_HmH sH tH bOrb GranteeLastName1Wd8(OJQJ_HmH sH tH ZOZ GranteeState Xd`CJOJQJ_HmH sH tH VOV GranteeZip Yd`CJOJQJ_HmH sH tH TOT LastName1Zd8(OJQJ_HmH sH tH VOV LastName21[d8(OJQJ_HmH sH tH ROR OtherID1\d8(OJQJ_HmH sH tH ROR Section2 ]d`CJOJQJ_HmH sH tH ^O^ SuperAreaCode1 ^d`CJOJQJ_HmH sH tH `O` SuperExtension1_d8(OJQJ_HmH sH tH dOd SuperPhoneNumber1`d8(OJQJ_HmH sH tH `O` SupervisorName1ad8(OJQJ_HmH sH tH LO"L Unit2 bd`CJOJQJ_HmH sH tH PO2P Worker2 cd`CJOJQJ_HmH sH tH `OB` WorkerAreaCode1 dd`CJOJQJ_HmH sH tH bORb WorkerExtension1ed8(OJQJ_HmH sH tH TObT WorkerFax fd`CJOJQJ_HmH sH tH XOrX WorkerName1gd8(OJQJ_HmH sH tH \O\ WorkerName2hd8(5OJQJ_HmH sH tH ZOZ WorkerPhone1id8(OJQJ_HmH sH tH ^O^ WorkerTitle1jd8(5OJQJ_HmH sH tH LOL Emailkd8(OJQJ_HmH sH tH 0T0Address1BureauCareOf CaseNumber ClientCity ClientState ClientZip CoAddress CoAreaCodeCoCity CoExtension CoPhoneNumber CoState CoSuppaddress CountyName CountyNumberCoZipDate1DistrictEmail/FaxAC FirstName FirstName2GranteeAddress1 GranteeCareof GranteeCityGranteeClientIDGranteeFirstNameGranteeLastName GranteeState GranteeZipLastName LastName2OtherID Section! SuperAreaCode"SuperExtension#SuperPhoneNumber$SupervisorName%Unit&Worker'WorkerAreaCode(WorkerExtension) WorkerFax* WorkerName+ WorkerName2, WorkerPhone- WorkerTitle.0Address1BureauCareOf CaseNumber ClientCity ClientState ClientZip CoAddress CoAreaCodeCoCity CoExtension CoPhoneNumberCoState CoSuppaddress CountyName CountyNumberCoZipDate1DistrictFaxAC FirstName FirstName2GranteeAddress1 GranteeCareof GranteeCityGranteeClientIDGranteeFirstName1GranteeLastName GranteeState GranteeZipLastName LastName2OtherIDSection SuperAreaCodeSuperExtensionSuperPhoneNumberSupervisorNameUnitWorkerWorkerAreaCodeWorkerExtension WorkerFax WorkerName WorkerName2 WorkerPhone WorkerTitleUser Input 10pt(<Pdu$5I]n  4EYm(<Pdx !B؎rʚB+07=HJKOPQe  #d#jNX:$.0!d!!!!PB !"#$%&'()*,-./12345689:;<@INB  &(4:<HNP\bdpsu"$035AGIU[]ilnz   ,24@CEQWYekmy"&(4:<HNP\bdpvxFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFF0Address1BureauCareOf CaseNumber ClientCity ClientState ClientZip CoAddress CoAreaCodeCoCity CoExtension CoPhoneNumberCoState CoSuppaddress CountyName CountyNumberCoZipdate1DistrictEmailFaxAC FirstName FirstName2GranteeAddress1 GranteeCareOf GranteeCityGranteeClientIDGranteeFirstNameGranteeLastName GranteeState GranteeZipLastName LastName2OtherIDSection SuperAreaCodeSuperExtensionSuperPhoneNumberSupervisorNameUnitWorkerWorkerAreaCodeWorkerExtension WorkerFax WorkerName WorkerName2 WorkerPhone WorkerTitle)=Qev%6J^o !5FZn)=Qey  !"#$%&'()*+,-./';Oct#4H\m 3DXl';OcwYq@ (```UnknownG: Times New Roman5Symbol3& : Arial?5 z Courier New5& zaTahoma;Wingdings"h0@P?Yq2