Get MN Home Study Assessment 2015-2024

Minnesota Adoption and Foster Care Home Study Assessment Supplemental Instructions for Completing the Assessment for Foster Residence Settings Applicant Applicant s Address City State Zip Code Period of validity 1 year 2 years Date assessment was completed Prepared By Agency Social Worker/Credentials Phone Number Email Address Supervisor/Credentials Agency Address Minnesota Statute and Rule requires all public and private adoption and foster care agencies to use the commissioner s designated format for completion of home studies and updates. Identify the section s of the home study that defines the reason s this family was recommended for denial of a foster care license Denial of adoptive placement adoption. Identify the section s of the home study that defines the reason s this family was not approved for Family strengths and needs - Identify the program strengths and needs in relation to providing family life for foster children. The following strengths and needs have been identified by the agency and the family Strengths Training plan The following training plan was developed with the applicant Needs Documentation of Minnesota Rules part 2960. 3210. Staff Training exempt for programs also licensed as 245B. Adoptive and foster parent history Refer to Assessment instructions DHS-4258D to complete this section. Personal history - Applicant 1 This section does not apply to Foster Residence Settings. Relationships This section does not apply to Foster Residence Settings. Children in the home This section does not apply to Foster Residence Settings with the exception of a child/ren of live-in staff if any. Reference Minnesota Rules part 2960. 3080 subpart 5 and part 2960. 3060 subpart 4 C D Family life Instructions DHS-4258D Family finances Document the license holder s understanding of the use of foster care maintenance found in Minnesota Rules part 9560. 0521 subpart 10 and Difficulty of Care DOC payment for children found in Minnesota Rules part 9560. 0521 subpart 7. Foster care maintenance payment means payment to cover the cost of the child s food clothing shelter daily supervision school supplies and personal incidentals and reasonable travel to the child s home for visitation. In case of institutional care the term includes the reasonable cost of administration and operation of the institution. Summary of collateral contacts and information Agency Credentials and Signatures This home study has been completed by an agency authorized by the State of Minnesota to provide adoption and/or foster care services. 3320. Denial of foster care licensure. The agency must make a recommendation to the Minnesota Department of Human Services Licensing Division to deny a foster care application. care licensure. Identify the section s of the home study that defines the reason s this family was recommended for denial of a foster care license Denial of adoptive placement adoption. Identify the section s of the home study that defines the reason s this family was not approved for Family strengths and needs - Identify the program strengths and needs in relation to providing family life for foster children. The following strengths and needs have been identified by the agency and the family Strengths Training plan The following training plan was developed with the applicant Needs Documentation of Minnesota Rules part 2960. 3210. Staff Training exempt for programs also licensed as 245B. Adoptive and foster parent history Refer to Assessment instructions DHS-4258D to complete this section. Personal history - Applicant 1 This section does not apply to Foster Residence Settings.