Department of Child Services Forms
To search this catalog: From the toolbar in the Edit menu, select "Find". When the Find search box appears, enter a keyword or form number. The first search result will display with the keyword or number highlighted, at the top of the page. Click "Find next" until the desired form is highlighted.
For forms labeled "PDF", the free Adobe Acrobat Reader software is required to view and in some cases fill them out. Forms in other formats (MS Word, MS Excel, etc) are indicated where appropriate.
To open a form once you have chosen it, click on the linked State Form Number (such as 01365.pdf).
For questions about individual forms, please contact this agency's forms coordinator, Scott Huffman at 317-232-4520 or his assistant Marisa Bland at 317-232-0602.
For questions about how to use this catalog, or to inform us of a technical problem, please send e-mail to the Forms Management Division.
Forms marked "read-only" cannot be filled in on your computer. They must be printed out and filled in by hand or typewriter.
Agency-wide Forms
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Title |
Form Number |
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DCS 0089 - Ledger of Disbursements and Appropriations (read-only) |
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DCS 0090 - Ledger of Disbursements and Receipts (read-only) |
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DCS 1103 - DCS Transferred Equipment and/or Furniture |
Child Support Bureau Forms
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Title |
Form Number |
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IV-D Applicant Information |
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Application for Title IV-D Child Support Services |
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Arrearage Calculation Worksheet |
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Authorization/Request for Paternity Blood Test (read-only) |
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Child Support Interoffice Notification |
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CSB 0010 Employer Online Payment System Website Setup Information |
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CSB 0013 Employer Remittance (read-only) |
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Direct Deposit Authorization |
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Financial Statement |
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Request for Case Closure |
Child Welfare Forms
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Title |
Form Number |
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Adoption Subsidy Agreement (read-only) |
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Annual Report Regarding Foster Family Home |
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Application for Child Abuse Research (read-only) |
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Application for Foster Family Home License (read-only) |
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Assessment / Authorization for Family & Children Emergency Services (read-only) |
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Child Registration: Indiana Special Needs Adoption Program (SNAP) Picture Book & Website (read-only) |
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Confidentiality Agreement (read-only) |
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Consent to Release Criminal History Information for Substitute Care Homes (read-only) |
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Consent to Release Social Security Number |
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CW 0001 Record of Training (read-only) |
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CW 0002S Notificación de Revision Periodica del Caso (read-only) |
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CW 0003S Notificación de la Audiencia para Terminar la Relacion Padre-Niño (read-only) |
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CW 0007S Nota de la Revision por Parte del Equipo Proteccion del Niño (read-only) |
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CW 0010S La Consideración de Derechos Legales en Custodia de la Toma de/Completar Una Petición a Nombre de un Niño Alegado para ser un Niño Necesitando de Servicios (read-only) |
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CW 0011S Aviso con Respecto a la Negación o Propuesta Acción para Suspender Asistencia de Adopción (read-only) |
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CW 0015 - Substitute Care Agreement (read-only) |
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CW 0019S: Asistencia de Emergencia - Notificacion de Accion / Emergency Assistance - Notice of Action |
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CW 0020 Adoption Assistance: Child Certification (read-only) |
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CW 0022S Notificacion de Accion (read-only) |
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CW 0023S Reporte de Cambio de Estatus en Niño/Familia (read-only) |
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CW 0024 Notice of Availability of Completed Reports and Information: Investigation of Allegations of Child Abuse or Neglect (read-only) |
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CW 0024S Aviso De Disponibilidad De Los Informes E Informacion Completados: Investigacion De Presunto Abuso O Negligencia Infantil (read-only) |
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CW 0025 Applicant's Statement of Attestation |
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CW 0025S Declaración Testimonial Del Aspirante (Applicant's Statement of Attestation) (read-only) |
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CW 0029 Guardianship Assistance Agreement (read-only) |
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CW 0038 - Medical Report for Household Members (read-only) |
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CW 0039 - Medical Report for Primary Caregivers (read-only) |
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CW 0040 - Safety Plan (read-only) |
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CW 0045: Consent to Release of Mental Health and Addiction Records |
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CW 0050 - Application for License to Operate a Children's Home or Child Care Institution (read-only) |
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CW 0051: Application for a License to Operate a Private Secure Facility |
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CW 0052 - Consent of Parent, Guardian, or Custodian to Interview Child(ren) (read-only) |
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CW 0100E Indiana Interstate Compact on the Placement of Children Financial/Medical Plan - If child is Placed Out-of-State (read-only) |
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CW 0310 Preliminary Report of Alleged Child Abuse or Neglect (read-only) |
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CW 1331 Consent to Adoption (read-only) |
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CW 1425 Application for License to Operate a Child Placing Agency |
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CW 2110 - Alternative Training Verification |
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CW 2113 Application for Emancipation Goods and Services (read-only) |
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CW 2114 Chafee Independent Living (IL) Voluntary Services Application and Service Agreement (read-only) |
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CW 2119 Foster, Adoptive, & Kinship Training (FAKT) Evaluation of Training |
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CW 2120 - Foster, Adoptive, and Kinship Training (FAKT) Evaluation of Trainee |
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CW 2125a - Foster Family / Adoptive Home Preparation Assessment Summary |
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CW 2128 - Request for a Child Protection Services (CPS) History Check |
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CW 2129 - Notice to Parent, Guardian, or Custodian of Interview with Child (read-only) |
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CW 2131 - Child Protection Services Intake Summary |
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CW 2132 Application for Foster Family Home License: Notice of Automatic System Withdrawal (read-only) |
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CW 2133 - Corrective Action Plan Notification: Probation (read-only) |
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CW 2310 - Initial Licensure Requirements Sheet for Foster Family Homes (read-only) |
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CW 2311 - Annual Review Requirements Sheet for Foster Family Homes (read-only) |
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CW 2312 - Relicensure Requirements Sheet for Foster Family Homes (read-only) |
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CW 2321 - Status Report for Completing Foster Family Home Annual Review (read-only) |
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CW 2324 - Notice of Substantiation of Report of Child Abuse or Neglect (read-only) |
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CW 3316 - Direct Vendor Payment Authorization and Certification (read-only) |
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CW 3340 - Voluntary Withdrawal of Application for Licensure or Relinquishment of Foster Family Home License (read-only) |
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CW 3341 - Referral to Medicaid Foster Care Independence Program (read-only) |
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CW 3345 - Independent Living Program: Case Plan for Use by Probation Officer (read-only) |
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CW 3347 - Independent Living Program: Discharge Summary (read-only) |
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CW 3415 - Foster Care / Adoption Information |
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CW 3416 - Paving the Way to a Decision (read-only) |
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CW 3417 - Foster Family Home Physical Environment Checklist (read-only) |
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CW 3418 - Status Report on Application for Foster Family Home Relicensure (read-only) |
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CW 3425 - Family Support / Community Services Plan (read-only) |
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CW 3517 - Child Behavioral / Health Challenges Checklist (read-only) |
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CW 3611 - Registration for Access to Obtain Name-Based Criminal History Checks (read-only) |
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CW 3618 - Initial Inquiry Regarding Foster Family Home Licensure (read-only) |
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CW 3619 Follow-up Action for Name-Based Check (read-only) |
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DCS 0326 - Individual Record - Allowance for Child / Payable from County Welfare Funds by Order of the Court (read-only) |
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DCS 0327 - Claim for Support of Children in Custody of Institutions Payable from Family & Children Funds by Order of Court (read-only) |
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Evaluation of Field Mentor by Supervisor of Trainee |
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Independent Living Transition Planning Toolkit (read-only) |
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Licensing Staff Inquiry Regarding Foster Family Home (read-only) |
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Nonrecurring Adoption Expenses Agreement (read-only) |
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Notice Regarding Denial or Proposed Action to Discontinue Adoption Assistance (read-only) |
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Purchase Order - Foster Care (read-only) |
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Recommendation For Foster Family Home Care License or Relative Home Care License |
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Renewal Notification Letter - Adoption Assistance Program (AAP) (read-only) |
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Request for Personal Reference Statement for Foster Family Home License Applicants |
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Review of Field Mentor by Trainee |
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Statement of Attestation by Relative Regarding Relationship (read-only) |
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Taking Custody Of A Child Without A Verbal Or Written Court Order: Description Of Circumstances (read-only) |
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