One form per child Please type ICPC 100A REV. 8/2001 INTERSTATE COMPACT ON THE PLACEMENT OF CHILDREN REQUEST FROM TO Notice is given of intent to place - Name of Child Social Security Number Sex Date of Birth SECTION I - IDENTIFYING DATA Ethnicity Hispanic Origin ICWA Eligible Yes No Unable to determine/unknown Race American Indian or Alaskan Native Asian Title IV-E determination Pending Name of Mother Native Hawaiian/ Other Pacific Islander Black or African American White Name of Agency or Person Responsible for Planning for Child Phone Address SECTION II - PLACEMENT INFORMATION Name of Person s or Facility Child is to be placed with Type of Care Requested Foster Family Home Group Home Care Child Caring Institution Residential Treatment Center Institutional Care-Article VI Adjudicated Delinquent Soc Sec optional Parent Relative Not Parent Relationship Other ADOPTION IV-E Subsidy To Be Finalized In Sending State Receiving State Current Legal Status of Child Sending Agency Custody/Guard....
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How to fill out the ICPC 100A online
The ICPC 100A form is essential for the placement of children across state lines under the Interstate Compact on the Placement of Children. This guide walks you through the process of completing the form online, ensuring you understand each section and field.
Follow the steps to successfully complete the ICPC 100A form.
- Press the ‘Get Form’ button to access the ICPC 100A form and open it for editing.
- Enter the child's name and Social Security number in the designated fields. Indicate if the child is eligible under the Indian Child Welfare Act (ICWA) by selecting 'Yes' or 'No'.
- Provide the child’s sex and gender in the appropriate fields. Fill out the ethnicity and race sections, choosing from the given options.
- Complete SECTION I by providing identifying data about the parents and agencies responsible for planning and financial responsibility for the child. Include names, contact information, and addresses.
- Move to SECTION II and indicate the type of care requested for the child, selecting from the listed options. Fill in the current legal status of the child and provide details about custody/guardianship.
- Specify the name and contact details of the person or facility where the child is to be placed, as well as any foster or adoptive resources.
- In SECTION III, indicate the services requested, including home studies and supervisory services required. Note any initial reports if applicable.
- Signature fields must be completed by the sending agency or responsible person, along with any necessary enclosures relative to the placement.
- SECTION IV will require you to select the action from the receiving state regarding the placement and obtain the signature of the receiving state's compact administrator.
- Once completed, review all entries for accuracy. Save the changes, then proceed to download, print, or share the form as necessary.
Complete your ICPC 100A form online today for efficient processing.
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