Get (application For Post Adoption Special Services Subsidy)

This guide provides detailed instructions on how to complete the Application For Post Adoption Special Services Subsidy online, ensuring a smooth and efficient submission process. By following these steps, users can accurately fill out the form and submit essential information regarding adoption services.

Follow the steps to complete your application effectively.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. In Section I, enter the name of the Public Children Services Agency (PCSA) where you will submit this application. Additionally, include the date of the application, specifying the month, day, and year.
3. Move to Section II: Family Data. Fill in the names of the adoptive father and mother, and provide the adoptive family’s current address and telephone number. Indicate the number of children residing in the home and specify the annual family income as reported on the latest IRS 1040 form.
4. Proceed to Section III: Child Data. Enter the first and last name of the adoptive child, their date of birth, and gender. Document the date when the adoption was finalized and select the appropriate type of adoption. Briefly describe the treatment needs for the child, ensuring the description meets the eligibility criteria as per the Ohio Administrative Code.
5. In Section IV, outline the services and/or therapeutic techniques requested. Specify the type of therapy being requested, the name of the provider, and the licensing board associated with the provider. Accurately list the cost of the requested services and check any additional services that apply. If applicable, complete the out of home care section with details about the residential treatment facility or agency.
6. Next, identify all community resources contacted in Section V to assist the child’s condition. Document the dates of contact and total funding received from each resource.
7. Finally, in Section VI: Affidavit, ensure all required documentation is attached. Sign the application to confirm the accuracy of information provided and acknowledge the right to a state hearing if needed.
8. Once all sections are filled out, review the application for accuracy. Save your changes, and consider downloading or printing the form for your records.

Complete your Application For Post Adoption Special Services Subsidy online today.