Guardianship Subsidy File Transfer Checklist
Date:
Child(ren) Name(s)/DCN:
Guardian(s) Name(s)/DVN:
Once the guardianship has been granted and the juvenile court has released jurisdiction, transfer the subsidy file to the subsidy worker within thirty (30) days. The following documentation should be included in the file:
Included in Transfer	Already Transferred	N/A	Documentation Needed
Initial Foster, Relative or Kinship Home Assessment and all Updates
Guardianship Petition- Please black out any identifying information of biological family (name, address, DOB, SSN, etc.) if TPR occurred
Guardianship Decree from Probate Court
Release-of-Jurisdiction Order from Juvenile Court after guardianship is completed.
Any correspondence related to the guardianship or subsidy
“Child Summary for Guardianship Placement” for each child
Summary of medical, dental information of each child (Include CW-103) and recent psychological evaluation
Printed Service Authorization for current services for each child (i.e. Daycare)
Payment requests pertaining to the reimbursement of related services
ICAMA forms completed for the Guardianship family, if applicable—must be completed for ICPC cases.
SS-61 for each child that has been updated to reflect Legal Guardianship status, guardianship placement and fund code updated by the eligibility specialist.
LG Subsidy Review Narrative
Guardianship Subsidy Application and Agreement approved by Director
Successor Guardianship Letter (CD-222)
Transfer Summary
Transfer Completed By:	Date:
Signature of Worker >
Transfer Approved By:	Date
Signature of Supervisor >
Transfer Accepted By:	Date
Signature of Subsidy Supervisor >