Forms
Title Type Posted
  • PDF
  • APS-0001
    Authorization for Adult Maltreatment Central Registry
    PDF05/29/2009
  • Cell Phone Cancellation of Service Instructions
    Cell Phone Cancellation of Service Instructions
    PDF04/07/2011
  • Cell Phone Ordering Instructions
    Cell Phone Ordering Instructions
    PDF04/07/2011
  • CFS-0000
    Cell Phone Order or Replacement Form
    PDF05/30/2013
  • CFS-0001
    Referral for Transitional Services & Support
    PDF01/01/2001
  • CFS-0002
    Life Plan & Agreement for Youth in Transition
    PDF01/01/2001
  • CFS-0003
    Checklist for Youth Exiting Care
    PDF01/01/2011
  • CFS-0004
    Request for After Care Support
    PDF01/01/2011
  • CFS-0015
    Request For Service/ Encumbrance
    PDF10/18/2013
  • CFS-0025
    Transitional Youth Services Budget
    XLS07/26/2012
  • PDF01/01/2011
  • CFS-0035
    TYS Coordinator Monthly Summary
    DOC01/01/2011
  • CFS-0050-A
    DCFS Volunteer Opportunities
    PDF08/11/2014
  • CFS-0050-B
    DCFS Volunteer Checklist
    PDF08/11/2014
  • CFS-0050-C
    Volunteer Application
    PDF08/11/2014
  • CFS-0050-D
    Confidentiality Statement for DCFS Volunteer
    PDF08/11/2014
  • CFS-0050-E
    DCFS Volunteer Agreement
    PDF08/11/2014
  • CFS-0099
    FASD Screening Referral Form
    PDF01/23/2014
  • CFS-0100
    Authorization for Release of Information for Differential Response
    PDF10/01/2012
  • CFS-0101
    FASD Plan of Safe Care
    PDF01/01/2013
  • CFS-0102
    DDS Medicaid Waiver Client Referral Form
    PDF02/01/2014
  • CFS-0103
    Referral for Adolescent Sexual Adjustment Project Assessment
    PDF10/09/2014
  • CFS-0149
    DCFS Prevention & Support Unit Supply Order
    PDF10/20/2014
  • CFS-0150
    Drug and Alcohol Screen Results
    PDF10/20/2014
  • CFS-0200
    Protection Plan
    PDF08/21/2013
  • CFS-0200 Instructions
    Protection Plan
    PDF08/21/2013
  • CFS-0200_Sp
    Protection Plan
    PDF08/21/2013
  • CFS-0201A
    Notice of Child Maltreatment Allegation to Law Enforcement and Prosecuting Attorney
    PDF10/01/2010
  • PDF03/16/2011
  • CFS-0202-A
    Notice of Child Maltreatment Allegation to Licensing/Registering Authority
    PDF09/19/2011
  • PDF03/16/2011
  • CFS-0204A
    Notice of Child Maltreatment Allegation to Legal Parent(s), Legal Guardian(s) and Current Foster Parent(s) of Alleged Offender in Foster Care
    PDF10/01/2010
  • PDF06/21/2010
  • CFS-0204-A Marshallese
    Notice of Child Maltreatment Allegation to Legal Parent(s), Legal Guardian(s) and Current Foster Parent(s) of Alleged Offender in Foster Care
    PDF10/01/2010
  • CFS-0204A Spanish
    Notice of Child Maltreatment Allegation to Legal Parent(s), Legal Guardian(s) and Current Foster Parent(s) of Alleged Offender in Foster Care (Spanish)
    PDF10/01/2010
  • CFS-0205-A
    Notice of Child Maltreatment Allegation to Legal Parent(s), Legal Guardian(s), and Current Foster Parent(s) of Alleged Victim(s) in Foster Care
    PDF10/01/2010
  • PDF06/21/2010
  • CFS-0205-A Spanish
    Notice of Child Maltreatment Allegation to Legal Parent(s), Legal Guardian(s), and Current Foster Parent(s) of Alleged Victim(s) in Foster Care (Spanish)
    PDF10/01/2010
  • CFS-0205-A_Marshallese
    Notice of Child Maltreatment Allegation to Legal Parent(s), Legal Guardian(s), and Current Foster Parent(s) of Alleged Victim(s) in Foster Care (Marshallese)
    PDF10/01/2010
  • CFS-0206-A
    Notice of Child Maltreatment Allegation to Attorney Ad Litem, CASA, and Counsel in Dependency Neglect or FINS Case of Alleged Victim(s)
    PDF10/01/2010
  • PDF03/16/2011
  • CFS-0208-A
    Notice of Child Maltreatment Allegation to Attorney Ad Litem and CASA of Alleged Offender
    PDF10/01/2010
  • PDF03/16/2011
  • CFS-0209-A
    Notice of Child Maltreatment Allegation to AAL or CASA of Child in Foster Home Where Maltreatment Is Reported or Where an Alleged Juvenile Offender or Underaged Juvenile Offender is Placed
    PDF10/01/2010
  • PDF03/16/2011
  • CFS-0210A
    Notice of Child Maltreatment Allegation to DHS Division Director; Coordinator of Multidisciplinary Team for Alleged Victim or Offender; and Counsel in Dependency Neglect or FINS Case for Alleged Offender
    PDF09/09/2011
  • PDF12/14/2009
  • PDF03/16/2011
  • CFS-0212-A
    Notice of Child Maltreatment Allegation to Alleged Offender
    PDF10/01/2010
  • CFS-0212-A Marshallese
    Notice of Child Maltreatment Allegation to Alleged Offender
    PDF10/01/2010
  • CFS-0212-A Spanish
    Notice of Child Maltreatment Allegation to Alleged Offender (Spanish)
    PDF09/20/2013
  • CFS-0213-A
    School District Prohibition from Notifying a Parent, Guardian, or Custodian of a Child Maltreatment Investigation
    PDF09/19/2011
  • PDF10/10/2011
  • CFS-0213-A Marshallese
    School District Prohibition from Notifying a Parent, Guardian, or Custodian of a Child Maltreatment Investigation
    PDF09/19/2011
  • CFS-0213-A Spanish
    School District Prohibition from Notifying a Parent, Guardian, or Custodian of a Child Maltreatment Investigation
    PDF09/19/2011
  • CFS-0214-R
    Notice of Child Maltreatment Allegation to Employer, Entity in Charge of Paid or Volunteer Activity, or Licensing or Registering Authority
    PDF03/16/2011
  • PDF03/16/2011
  • CFS-0214-R1
    Follow-up Notice to Employer or Volunteer Coordinator, or Licensing or Registering Authority Regarding Child Maltreatment Allegation
    PDF03/16/2011
  • PDF03/16/2011
  • CFS-0215-R
    Risk Determination of Certain Individuals under Care of Alleged Offender
    PDF08/21/2013
  • PDF03/16/2011
  • CFS-0220
    DCFS True Investigation File Cover Sheet
    PDF08/11/2014
  • CFS-0221-T
    Child Maltreatment True Investigative Determination Notice to Law Enforcement and Prosecuting Attorney
    PDF03/16/2011
  • PDF03/16/2011
  • CFS-0222-T
    Notice of True Determination to Facility Director
    PDF10/10/2010
  • PDF02/21/2012
  • CFS-0223-T1
    Child Maltreatment True Investigative Determination Notice to Underaged Juvenile Offender (under 14 years old)
    PDF08/11/2014
  • CFS-0223-T1_Sp
    Child Maltreatment True Investigative Determination Notice to Underaged Juvenile Offender (under 14 years old)_Spanish
    PDF08/21/2013
  • CFS-0223-T3
    Child Maltreatment True Investigative Determination Notice to Alleged Juvenile Offender 14-17 Years of Age
    PDF08/21/2013
  • CFS-0223-T3_Sp
    Child Maltreatment True Investigative Determination Notice to Alleged Juvenile Offender 14-17 Years of Age
    PDF08/21/2013
  • CFS-0223-T4
    Child Maltreatment True Investigative Determination Notice to Alleged Juvenile Offender (if currently age 18 or older)
    PDF01/01/2014
  • CFS-0224-T1
    Child Maltreatment True Investigative Determination Notice to Legal Parents and Guardians of Underaged Juvenile Offender (under 14 years old)
    PDF08/21/2013
  • CFS-0224-T3
    Child Maltreatment True Investigative Determination Notice to Legal Parents and Guardians of Alleged Juvenile Offender 14-17 Years of Age
    PDF08/21/2013
  • CFS-0224-T1_Spanish
    Child Maltreatment True Investigative Determination Notice to Legal Parents and Guardians of Underaged Juvenile Offender (under 14 years old)_Spanish
    PDF08/21/2013
  • CFS-0224-T3_Spanish
    Child Maltreatment True Investigative Determination Notice to Legal Parents and Guardians of Alleged Juvenile Offender 14-17 Years of Age_Spanish
    PDF08/21/2013
  • CFS-0224-T4
    Child Maltreatment True Investigative Determination Notice to Current Foster Parents of the Alleged Offender in Foster Care
    PDF02/20/2012
  • CFS-0224-T4_Spanish
    Child Maltreatment True Investigative Determination Notice to Current Foster Parents of the Alleged Offender in Foster Care_Spanish
    PDF02/20/2012
  • CFS-0225-T1
    Child Maltreatment True Investigative Determination Notice to Victim, Legal Parent(s), and Legal Guardian(s) of the Alleged Victim
    PDF10/01/2010
  • PDF08/01/2009
  • CFS-0225-T1_Spanish
    Child Maltreatment True Investigative Determination Notice to Victim, Legal Parent(s), and Legal Guardian(s) of the Alleged Victim (Spanish)
    PDF10/01/2010
  • CFS-0225-T2
    Child Maltreatment True Investigative Determination Notice to Current Foster Parents of Alleged Victim in Foster Care
    PDF10/01/2010
  • CFS-0225-T2_Spanish
    Child Maltreatment True Investigative Determination Notice to Current Foster Parents of Alleged Victim in Foster Care_Spanish
    PDF10/01/2010
  • PDF12/04/2009
  • CFS-0226-T1
    Child Maltreatment True Investigative Determination Notice to Circuit Judge, Attorney Ad Litem, CASA, and Counsel in Dependency Neglect or FINS Case of Alleged Victim
    PDF09/19/2011
  • PDF03/16/2011
  • CFS-0228-T
    Child Maltreatment True Investigative Determination Notice to Attorney Ad Litem and CASA of Alleged Offender
    PDF09/19/2011
  • PDF03/16/2011
  • CFS-0229-T
    Child Maltreatment True Investigative Determination Notice to Attorney Ad Litem and CASA for Child in Foster Home Where Maltreatment Is Reported
    PDF09/19/2011
  • PDF03/16/2011
  • CFS-0230-T1
    Child Maltreatment True Investigative Determination Notice to DHS Division Director; Coordinator of Multidisciplinary Team for Alleged Victim or Offender; and Circuit Judge and Counsel in Dependency Neglect or FINS Case for Alleged Offender
    PDF02/20/2010
  • PDF12/14/2009
  • CFS-0231-T
    Child Maltreatment True Investigative Determination Notice to School Where Victim Is Enrolled
    PDF10/01/2010
  • PDF03/16/2011
  • CFS-0232-T EH
    Expedited Hearing Request
    PDF08/01/2009
  • CFS-0232-T2
    True But Exempt Child Maltreatment Investigative Determination Notice to Offender
    PDF01/14/2013
  • PDF08/01/2009
  • CFS-0232-T2 Spanish
    True But Exempt Child Maltreatment Investigative Determination Notice to Offender (Spanish)
    PDF08/01/2009
  • CFS-0232-T2 Marshallese
    True But Exempt Child Maltreatment Investigative Determination Notice to Offender
    PDF08/01/2009
  • PDF08/01/2009
  • CFS-0232-T PH
    Request for Preliminary Administrative Hearing
    PDF10/01/2010
  • PDF08/01/2009
  • CFS-0232-T1
    Child Maltreatment True Investigative Determination Notice to Alleged Offender
    PDF04/13/2013
  • CFS-0232-T1 A
    Witness Statement of Notice of Investigative Determination
    PDF08/01/2009
  • CFS-0232-T1 A Spanish
    Witness Statement of Notice of Investigative Determination (Spanish)
    PDF08/01/2009
  • PDF04/13/2010
  • CFS-0232-T1 Marshallese
    Child Maltreatment True Investigative Determination Notice to Alleged Offender
    PDF08/01/2009
  • CFS-0232-T1 Spanish
    Child Maltreatment True Investigative Determination Notice to Alleged Offender (Spanish)
    PDF08/01/2009
  • CFS-0233-T
    Child Maltreatment Expedited Hearing Notice to Alleged Offender
    PDF08/01/2009
  • PDF08/01/2009
  • CFS-0233-T Spanish
    Child Maltreatment Expedited Hearing Notice to Alleged Offender (Spanish)
    PDF08/01/2009
  • CFS-0234-T
    Child Maltreatment True Investigative Determination Notice to Licensing or Registering Authority and Employer or Entity in Charge of Paid or Volunteer Activity
    PDF09/19/2011
  • PDF03/16/2011
  • CFS-0240-U1
    Unsubstantiated Child Maltreatment Investigative Determination to Alleged Underaged Juvenile Offender (under 14 years old)
    PDF08/21/2013
  • CFS-0240-U-1 Marshallese
    Unsubstantiated Child Maltreatment Investigative Determination to Alleged Underaged Juvenile Offender (under 14 years old)
    PDF08/21/2103
  • CFS-0240-U1_Spanish
    Unsubstantiated Child Maltreatment Investigative Determination to Alleged Underaged Juvenile Offender (under 14 years old)
    PDF08/21/2013
  • CFS-0240-U2
    Unsubstantiated Child Maltreatment Investigative Determination to Alleged Juvenile Offender 14-17 Years of Age
    PDF08/21/2013
  • CFS-0240-U-2 Marshallese
    Unsubstantiated Child Maltreatment Investigative Determination to Alleged Juvenile Offender 14-17 Years of Age
    PDF08/21/2013
  • CFS-0240-U2_Spanish
    Unsubstantiated Child Maltreatment Investigative Determination to Alleged Juvenile Offender 14-17 Years of Age (Spanish)
    PDF08/01/2009
  • CFS-0241-U
    Notice of Unsubstantiated Child Maltreatment Investigative Determination to Law Enforcement and Prosecuting Attorney
    PDF08/01/2009
  • PDF03/16/2011
  • CFS-0242-U
    Notice of Unsubstantiated Child Maltreatment Investigative Determination to Licensing or Registering Authority
    PDF09/19/2011
  • PDF03/16/2011
  • CFS-0243-U
    Notice of Unsubstantiated Child Maltreatment Investigative Determination to Facility Director
    PDF09/19/2011
  • PDF03/16/2011
  • CFS-0244-U
    Offer of Supportive Services as a Result of Unsubstantiated Child Maltreatment Investigative Determination to Legal Parent(s) and Legal Guardian(s) of Alleged Offender
    PDF09/19/2011
  • CFS-0245-U
    Notice of Unsubstantiated Child Maltreatment Investigative Determination to Legal Parent(s), Legal Guardians, and Current Foster Parents of the Alleged Victim
    PDF08/01/2009
  • PDF08/01/2009
  • CFS-0245-U_Spanish
    Notice of Unsubstantiated Child Maltreatment Investigative Determination to Legal Parent(s), Legal Guardians, and Current Foster Parents of the Alleged Victim (Spanish)
    PDF10/01/2010
  • CFS-0245-U1
    Notice of Unsubstantiated Child Maltreatment Investigative Determination to Alleged Victim
    PDF08/01/2009
  • PDF08/01/2009
  • CFS-0245-U1_Spanish
    Notice of Unsubstantiated Child Maltreatment Investigative Determination to Alleged Victim (Spanish)
    PDF10/01/2010
  • CFS-0246-U
    Notice of Unsubstantiated Child Maltreatment Investigative Determination to Circuit Judge, Attorney Ad Litem, CASA, and Counsel in Dependency Neglect or FINS Case of Alleged Victim
    PDF09/19/2011
  • PDF08/01/2009
  • CFS-0248-U
    Notice of Unsubstantiated Child Maltreatment Investigative Determination to Attorney Ad Litem and CASA for Alleged Offender
    PDF09/19/2011
  • PDF03/16/2011
  • CFS-0249-U
    Notice of Unsubstantiated Child Maltreatment Investigative Determination to Attorney Ad Litem and CASA of Child in Foster Home Where Maltreatment Is Reported
    PDF09/19/2011
  • PDF03/16/2011
  • CFS-0250-U
    Notice of Unsubstantiated Child Maltreatment Investigative Determination to DHS Division Director; Coordinator of Multidisciplinary Team for Alleged Victim or Offender; and Circuit Judge or Counsel in Dependency Neglect or FINS Case for Alleged Offender
    PDF09/19/2011
  • PDF12/14/2009
  • CFS-0252-U
    Notice of Unsubstantiated Child Maltreatment Investigative Determination to Alleged Offender
    PDF08/01/2009
  • PDF08/01/2009
  • CFS-0252-U_Marshallese
    Notice of Unsubstantiated Child Maltreatment Investigative Determination to Alleged Offender
    PDF08/01/2009
  • CFS-0252-U_Spanish
    Notice of Unsubstantiated Child Maltreatment Investigative Determination to Alleged Offender (Spanish)
    PDF10/10/2010
  • CFS-0254-U
    Notice of Unsubstantiated Child Maltreatment Investigative Determination to Alleged Offender’s Employer or Entity in Charge of Alleged Offender’s Paid or Volunteer Activity; or Licensing or Registering Authority
    PDF10/10/2010
  • PDF03/16/2011
  • CFS-0261-O
    Notice of Overturned True Child Maltreatment Investigative Determination to Law Enforcement and Prosecuting Attorney
    PDF10/10/2010
  • PDF03/16/2011
  • CFS-0263-O
    Notice of Overturned True Child Maltreatment Investigative Determination to Facility Director
    PDF10/10/2010
  • PDF03/16/2011
  • CFS-0264-O
    Notice of Overturned True Child Maltreatment Investigative Determination to Legal Parent(s) and Legal Guardian(s) of the Alleged Offender
    PDF10/10/2010
  • PDF08/01/2009
  • CFS-0264-O_Spanish
    Notice of Overturned True Child Maltreatment Investigative Determination to Legal Parent(s) and Legal Guardian(s) of the Alleged Offender (Spanish)
    PDF10/01/2010
  • CFS-0265-O1
    Notice of Overturned True Child Maltreatment Investigative Determination to Victim and Legal Parent(s) and Legal Guardian(s) of Alleged Victim
    PDF08/01/2009
  • CFS-0265-O1_Spanish
    Notice of Overturned True Child Maltreatment Investigative Determination to Victim and Legal Parent(s) and Legal Guardian(s) of Alleged Victim (Spanish)
    PDF10/01/2010
  • PDF08/01/2009
  • CFS-0265-O2
    Notice of Overturned True Child Maltreatment Investigative Determination to Current Foster Parent(s) of the Alleged Victim
    PDF08/01/2009
  • PDF08/01/2009
  • CFS-0266-O
    Notice of Overturned True Child Maltreatment Investigative Determination to Circuit Judge, Attorney Ad Litem, CASA, and Counsel in Dependency Neglect or FINS Case of Alleged Victim
    PDF08/01/2009
  • PDF03/16/2011
  • CFS-0268-O
    Notice of Overturned True Child Maltreatment Investigative Determination to Attorney Ad Litem and CASA of Alleged Offender
    PDF08/01/2009
  • PDF03/16/2011
  • CFS-0269-O
    Notice of Overturned True Child Maltreatment Investigative Determination to Attorney Ad Litem and CASA of Child in Foster Home Where Maltreatment Is Reported
    PDF08/01/2009
  • PDF03/16/2011
  • CFS-0270-O
    Notice of Overturned True Child Maltreatment Investigative Determination to DHS Division Director; Coordinator of Multidisciplinary Team for Alleged Victim and Offender; and Circuit Judge and Counsel in Dependency Neglect or FINS Case of Alleged Offender
    PDF12/14/2009
  • PDF12/14/2009
  • CFS-0272-O
    Notice of Overturned True Child Maltreatment Investigative Determination to Alleged Offender
    PDF08/01/2009
  • PDF08/01/2009
  • CFS-0272-O_Spanish
    Notice of Overturned True Child Maltreatment Investigative Determination to Alleged Offender (Spanish)
    PDF10/01/2010
  • CFS-0274-O
    Notice of Overturned True Child Maltreatment Investigative Determination to Licensing or Registering Authority and Employer or Entity in Charge of Paid or Volunteer Activity
    PDF08/01/2009
  • PDF03/16/2011
  • CFS-0275-O
    Notice of Overturned True Child Maltreatment Investigative Determination to Child Safety Center Involved in Investigation of Maltreatment
    PDF08/01/2009
  • PDF03/16/2011
  • CFS-0281-N
    Notice of Name Placement on Central Registry to Law Enforcement and Prosecuting Attorney
    PDF08/01/2009
  • PDF03/16/2011
  • CFS-0283-N
    Notice of Name Placement on Central Registry to Facility Director
    PDF08/01/2009
  • PDF03/16/2011
  • CFS-0284-N
    Notice of Name Placement on Central Registry to Legal Parent(s) and Legal Guardian(s) of the Juvenile Offender (14 to 17 Years of Age)
    PDF08/21/2013
  • PDF08/01/2009
  • CFS-0284-N Marshallese
    Notice of Name Placement on Central Registry to Legal Parent(s) and Legal Guardian(s) of the Juvenile Offender (14 to 17 Years of Age)
    PDF08/21/2013
  • CFS-0284-N Spanish
    Notice of Name Placement on Central Registry to Legal Parent(s) and Legal Guardian(s) of the Juvenile Offender (14 to 17 Years of Age)_Spanish
    PDF08/21/2013
  • CFS-0285-N
    Notice of Name Placement on Central Registry to Victim, Legal Parent(s), Legal Guardian(s), and Current Foster Parent(s) of Victim
    PDF08/01/2009
  • PDF08/01/2009
  • CFS-0285-N Spanish
    Notice of Name Placement on Central Registry to Victim, Legal Parent(s), Legal Guardian(s), and Current Foster Parent(s) of Victim (Spanish)
    PDF10/01/2010
  • CFS-0285-N_Marshallese
    Notice of Name Placement on Central Registry to Victim, Legal Parent(s), Legal Guardian(s), and Current Foster Parent(s) of Victim (Marshallese)
    PDF10/01/2010
  • CFS-0286-N
    Notice of Name Placement on Central Registry to Circuit Judge, Attorney Ad Litem, CASA, and Counsel in Dependency Neglect or FINS Case of Victim
    PDF08/01/2009
  • PDF03/16/2011
  • CFS-0288-N
    Notice of Name Placement on Central Registry to Attorney Ad Litem and CASA of Offender
    PDF08/01/2009
  • PDF03/16/2011
  • CFS-0289-N
    Notice of Name Placement on Central Registry to Attorney Ad Litem and CASA of Child in Foster Home Where Maltreatment Is Reported
    PDF08/01/2009
  • PDF03/16/2011
  • CFS-0290-N
    Notice of Name Placement on Central Registry to DHS Division Director; Coordinator of Multidisciplinary Team for Offender and Victim; and Circuit Judge and Counsel in Dependency Neglect or FINS Case of Offender
    PDF12/14/2009
  • PDF12/14/2009
  • CFS-0291-N1
    Notice of Name Placement on Central Registry to School Where Victim Is Enrolled
    PDF08/01/2009
  • PDF03/16/2011
  • CFS-0291-N2
    Notice of Name Placement on Central Registry to School Where Offender Is Enrolled
    PDF08/01/2009
  • PDF03/16/2011
  • CFS-0292-N
    Notice of Name Placement on Central Registry to Offender
    PDF04/11/2011
  • PDF10/01/2010
  • CFS-0292-N_Spanish
    Notice of Name Placement on Central Registry to Offender (Spanish)
    PDF10/01/2010
  • CFS-0294-N
    Notice of Name Placement on Central Registry to Licensing or Registering Authority, Employer, or Entity in Charge of a Paid or Volunteer Activity
    PDF04/11/2011
  • PDF03/16/2011
  • CFS-0295-N
    Notice of Name Placement on Central Registry to Child Safety Center Involved in Investigation of Maltreatment
    PDF04/11/2011
  • PDF03/16/2011
  • CFS-0296-N
    Notice of Name Placement on Central Registry to Employer of Offender in a Designated Position with an Arkansas State Agency
    PDF04/11/2011
  • PDF03/16/2011
  • CFS-0299
    Investigation Checklist for Supervisors
    PDF03/28/2014
  • CFS-0300A
    Attorney-Ad-Litem, Court Appointed Special Advocate and Child Notification of Changes in Out-of-Home Placement
    PDF11/01/2005
  • CFS-0300
    Notification of Changes in Out-of-Home Placement
    PDF11/01/2005
  • PDF11/01/2005
  • CFS-0300 Spanish
    Notification of Changes in Out-of-Home Placement (Spanish)
    PDF11/01/2005
  • PDF11/01/2005
  • CFS-0302
    Interdivisional Staffing Summary Form
    DOC01/01/2014
  • CFS-0303
    Out of State Placement
    PDF01/01/2014
  • CFS-0304
    Justification for Special Board Rate Form
    PDF04/11/2011
  • PDF03/16/2011
  • CFS-0305
    Near Fatality Disclosure Case Briefing Summary
    PDF08/21/2013
  • CFS-0306
    Documentation of Child’s Medical Episode Related to Near Fatality
    PDF08/21/2013
  • CFS-0306-A
    Documentation of Original Near Fatality Subsequently Resulting in Fatality
    PDF08/21/2013
  • CFS-0307
    Child Fatality Disclosure Case Briefing Summary
    PDF08/21/2013
  • CFS-0308
    CHILD DEATH REVIEW PACKET CHECKLIST
    PDF08/21/2013
  • CFS-0309
    Child Fatality Internal Review Staffing
    PDF08/21/2013
  • CFS-0313
    Office of Chief Counsel Review of Administrative Hearing Investigative Determination
    PDF02/01/2008
  • CFS-0316
    REQUEST FOR CHILD MALTREATMENT CENTRAL REGISTRY CHECK
    PDF08/24/2011
  • PDF11/12/2014
  • CFS-0317
    Off-Site Worker's Safety Log
    DOC10/29/2009
  • PDF10/29/2009
  • CFS-0320
    Administrative Hearing Statement
    PDF04/13/2010
  • PDF04/13/2010
  • CFS-0321
    Referral for Investigation
    PDF06/01/2009
  • PDF06/01/2009
  • CFS-0322
    Homemaker Referral
    DOC06/01/2009
  • PDF03/16/2011
  • CFS-0323
    Protective Custody/Parental Notification
    PDF08/21/2013
  • CFS-0323_Sp
    Protective Custody/Parental Notification (Spanish)
    PDF08/21/2013
  • CFS-0323-A Spanish
    Notice to Adult Relatives by Blood or Adoption that a Child Has Been Taken into DCFS Custody (Spanish)
    PDF11/01/2011
  • PDF02/01/2011
  • CFS-0323-A
    A Notice to Adult Relatives by Blood, Adoption or Marriage that a child has been taken into DCFS custody.
    PDF11/01/2011
  • CFS-0323_Marshallese
    Protective Custody/Parental Notification (Marshallese)
    PDF08/21/2013
  • CFS-0323-B
    Notice to Fictive Kin that a child has been taken into DCFS custody
    PDF08/21/2013
  • PDF02/01/2011
  • CFS-0323-B_Sp
    Notice to Fictive Kin or Adult Relatives that a Child Has Been Taken into DCFS Custody (Spanish)
    PDF08/21/2013
  • CFS-0324
    Checklist of Homemaker’s Activities
    DOC08/01/2009
  • PDF03/16/2011
  • CFS-0325
    Notification of Complaint Other Than Child Maltreatment
    PDF08/01/2009
  • CFS-0326
    Outcome of Complaint Investigation (Other Than Child Maltreatment)
    PDF08/01/2009
  • CFS-0327
    Notification of Name Removal from the Central Registry
    PDF08/01/2009
  • CFS-0327 Spanish
    Spanish Notification of Name Removal from the Central Registry (Spanish)
    PDF06/01/2009
  • CFS-0327-A
    Physical Documentation - Body Diagram
    DOC08/27/2012
  • CFS-0328-A
    Request for Name Removal From the Central Registry
    PDF08/11/2014
  • PDF08/01/2009
  • CFS-0328-B
    Request for Name Removal from the Central Registry by Juvenile Offender
    PDF08/11/2014
  • PDF08/15/2009
  • CFS-0328-C
    Child Maltreatment Central Registry Review Team Decision Letter to Requestor
    PDF08/11/2014
  • CFS-0330
    Protective Services Alert Notification
    DOC07/01/2004
  • CFS-0332
    Income Assistance Request Log
    DOC08/01/2009
  • CFS-0333
    Client Information Sheet for Cash Assistance and Foster Care Incidentals
    DOC08/01/2009
  • PDF
  • CFS-0334
    Foster Care Services - Authorization For Billing
    PDF08/01/2010
  • PDF08/01/2010
  • CFS-0336
    Expiration of Protective Custody/Parental Notification
    PDF08/21/2013
  • CFS-0336 Spanish
    Expiration of Protective Custody/Parental Notification (Spanish)
    PDF08/21/2013
  • CFS-0336_Marshallese
    Expiration of Protective Custody/Parental Notification (Marshallese)
    PDF08/21/2013
  • CFS-0340
    PERMANENCY ROUNDTABLE REFERRAL FORM
    PDF02/20/2012
  • CFS-0341
    Certification of Absence of Criminal Record (for youth ages 10-17)
    PDF01/01/2014
  • CFS-0341_Spanish
    Certification of Absence of Criminal Record (For Youth Age 10-17)
    PDF01/01/2014
  • CFS-0342
    State Police Criminal Record Check
    PDF08/22/2011
  • CFS-0343
    Notification of Court Appearance
    PDF11/01/2011
  • CFS-0343_Spanish
    Notification of Court Appearance (Spanish)
    PDF11/01/2011
  • CFS-0345
    Intensive Family Services Referral
    PDF09/21/2010
  • CFS-0347
    Intensive Family Services Family Counselor’s Time Record
    DOC08/01/2009
  • PDF03/16/2011
  • CFS-0351
    Initial Dental Examination
    DOC08/01/2009
  • PDF03/16/2011
  • CFS-0352
    Medical, Dental, Vision, Hearing & Psychological Episodic Form
    PDF06/10/2010
  • PDF06/10/2010
  • CFS-0353
    Requested Medical Records Log
    DOC08/01/2009
  • PDF03/16/2011
  • CFS-0354
    Team Decision Making Sign-In Sheet for Meeting Participants
    PDF09/15/2014
  • CFS-0355
    Team Decision Making Team Meeting Summary Report
    PDF09/15/2014
  • CFS-0360
    Request for Conference/Training
    PDF07/01/1995
  • CFS-0362
    Medi-Alert to Foster Care Provider
    DOC04/09/2007
  • PDF04/09/2007
  • CFS-0363
    Foster Parent, Adoptive Parent or Applicant Smoking Certification
    PDF05/28/2013
  • PDF02/01/2008
  • CFS-0363 Spanish
    Foster Parent, Adoptive Parent or Applicant Smoking Certification (Spanish)
    PDF02/01/2008
  • CFS-0365
    Receipt for Medical Passport of a foster child and acknowledgement of confidential nature of information contained in the Medical Passport.
    PDF04/12/2011
  • PDF03/16/2011
  • CFS-0367
    Specialized Placement Referral Form
    PDF08/02/2013
  • PDF11/01/2010
  • CFS-0368
    Child’s Health Services Plan
    DOC08/01/2009
  • PDF03/16/2011
  • CFS-0370
    Residence Checklist for Youth
    PDF06/01/2011
  • CFS-0376
    Authorization for Billing & Trust Account Action
    PDF01/01/2011
  • CFS-0377
    Facility Trust Account Report
    PDF11/02/2009
  • CFS-0379
    Close Out/Overpayment Notification
    PDF11/02/2009
  • CFS-0380
    Trust Account Invoice
    PDF11/02/2009
  • CFS-0381
    Training Record Log
    PDF10/01/1993
  • CFS-0384
    Notification to Local Education Agency of Changes in Child Placement, Changes in Schools or Experiences of Traumatic Events
    PDF08/01/2009
  • PDF03/16/2011
  • CFS-0386
    Used when the CHRIS system is down for basic case information.
    DOC04/11/2011
  • CFS-0388
    Application & Agreement to Participate in DCFS Foster Care Driver's License Program
    PDF12/04/2009
  • PDF03/16/2011
  • CFS-0388_Spanish
    Application & Agreement to Participate in DCFS Foster Care Driver's License Program (Spanish)
    PDF12/04/2009
  • CFS-0389
    Application & Agreement to Participate in DCFS Foster Care Driving Insurance Reimbursement Program
    PDF01/13/2010
  • PDF01/13/2010
  • CFS-0389_Spanish
    Application & Agreement to Participate in DCFS Foster Care Driving Insurance Reimbursement Program (Spanish)
    PDF12/04/2009
  • CFS-0397
    Educational Assessment
    PDF05/01/1994
  • PDF03/16/2011
  • CFS-0404
    General Medical Report
    PDF02/06/2013
  • CFS-0408
    Federal Parent Locator System Information
    PDF08/01/2009
  • PDF03/16/2011
  • CFS-0409
    Foster/Adoptive Family Preference Checklist
    PDF05/01/2014
  • OPLS-0410
    Relinquishment of Parental Rights Waiver of Notice Entry of Appearance
    PDF08/21/2013
  • OPLS-0410_Spanish
    Relinquishment of Parental Rights Waiver of Notice Entry of Appearance (Spanish)
    PDF08/21/2013
  • CFS-0411
    Affidavit
    PDF11/02/2009
  • CFS-0414
    Adoption Services Change of Status
    PDF10/01/2005
  • PDF10/01/2005
  • CFS-0418
    Notice of Custody w/Power to Consent to Adoption Procedure
    PDF08/01/2009
  • CFS-0419
    Foster Family Support System (FFSS) Information
    PDF01/01/2011
  • CFS-0420
    Legal Risk Adoption Placement Agreement
    PDF08/01/2009
  • PDF04/01/2013
  • CFS-0423
    Certificate of Service
    PDF09/01/2008
  • CFS-0425
    Application for Adoption Subsidy
    PDF04/22/2013
  • CFS-0426
    Statement of Income and Resources for Adoption Subsidy
    PDF08/01/2009
  • PDF04/01/2013
  • CFS-0427
    DETERMINATION OF ELIGIBILITY FOR ADOPTION SUBSIDY
    PDF05/28/2013
  • PDF03/16/2011
  • CFS-0428A
    Adoption Assistance Agreement for State Funded Subsidy Payments
    PDF08/11/2014
  • PDF08/01/2007
  • CFS-0428B
    Adoption Assistance Agreement for Federal IV-E Funded Assistance
    PDF08/11/2014
  • PDF08/01/2007
  • CFS-0428C
    Adoption Assistance Agreement For Non-Recurring Adoption Expense Payment
    PDF05/28/2013
  • CFS-0429
    Special Adoption Subsidy Determination
    PDF05/28/2013
  • PDF11/01/2007
  • CFS-0431
    Certification of Adoption Subsidy Eligibility
    PDF04/01/2013
  • PDF06/01/2007
  • CFS-0432
    Recommendation for Finalization of an Adoption
    PDF04/01/2013
  • PDF03/16/2011
  • CFS-0433
    Individualized Adoption Recruitment Plan
    PDF09/01/2003
  • PDF03/16/2011
  • CFS-0434
    Mutual Consent Voluntary Adoption Registry
    PDF05/28/2013
  • CFS-0435-B
    Notification of Subsidized Guardianship Program Denial
    PDF04/01/2013
  • CFS-0435-A
    A Subsidized Guardianship Application and Checklist
    PDF11/01/2011
  • CFS-0435-C
    Subsidized Guardianship Special Subsidy Request
    PDF11/01/2011
  • CFS-0435-D
    Recommendation for Finalization of Guardianship
    PDF04/16/2012
  • CFS-0435-E
    Consent to Guardianship
    PDF09/01/2012
  • CFS-0435-F
    Guardianship Assistance Agreement
    PDF01/01/2013
  • CFS-0435G
    Annual Subsidized Guardianship Review
    PDF01/01/2013
  • CFS-0435-H
    Notice of Modification or Termination of Subsidized Guardianship Agreement
    PDF01/01/2013
  • CFS-0445
    Foster Home Needs Assessment
    DOC01/01/2005
  • CFS-0446
    In Home Consultation Visit Report
    PDF08/21/2013
  • PDF01/01/2011
  • CFS-0450
    Prospective Provisional Foster Parent Information & Questionnaire
    PDF01/01/2014
  • CFS-0450 Instructions
    Prospective Provisional Foster Parent Information & Questionnaire
    PDF01/06/2014
  • CFS-0451
    Foster Parent Re-Evaluation
    DOC02/01/2005
  • PDF02/01/2005
  • CFS-0452
    Provisional Foster Home Verification
    PDF08/01/2009
  • CFS-0455
    Request / Consent for Health Department Services
    PDF03/01/2008
  • PDF11/12/2014
  • CFS-0456
    Birth Family Background Information
    DOC08/01/2009
  • CFS-0457
    Hospital Data
    PDF02/01/2005
  • PDF02/01/2005
  • CFS-0462
    Initial Foster Home Agreement
    PDF08/01/2009
  • CFS-0462-A
    Foster Home Agreement Addendum
    PDF08/01/2009
  • CFS-0465
    Foster Parent Orientation Checklist
    PDF02/08/2013
  • CFS-0465_Spanish
    Foster Parent Orientation Checklist (Spanish)
    PDF11/02/2004
  • PDF03/16/2011
  • CFS-0467
    Adoption Recruitment Agreement
    PDF08/01/2009
  • CFS-0470
    Selection of Adoptive Family
    PDF05/28/2013
  • PDF09/01/2003
  • CFS-0471
    Disclosure for Adoption
    PDF08/01/2009
  • PDF03/16/2011
  • CFS-0474
    Provisional Foster Home Orientation Checklist
    PDF11/02/2009
  • PDF11/02/2009
  • CFS-0475A
    Initial Checklist for Foster/Adoptive Home Assessment
    PDF08/21/2013
  • CFS-0475D
    Transfer of Foster Home from Another County
    PDF08/22/2011
  • CFS-0475G
    Checklist for Foster Home Closure
    PDF08/22/2011
  • CFS-0475E
    Complaint Against Foster Family Other Than Child Maltreatment
    PDF08/22/2011
  • CFS-0475-B
    Quarterly Monitoring Checklist for Foster Home
    PDF08/04/2011
  • CFS-0475C
    Reevaluation Checklist for Foster/Pre-Adoptive Home
    PDF08/21/2013
  • CFS-0475-F
    True Reports of Child Maltreatment Against Foster Family Members
    PDF08/24/2011
  • DOC01/01/2011
  • CFS-0476
    DCFS Training Completion Certificate
    PDF01/01/2008
  • CFS-0480
    Alternate Compliance of Water Supply Agreement
    PDF02/01/2005
  • PDF02/01/2005
  • CFS-0484
    Landlord Notification of Potential Tenant Foster Care Services
    PDF08/27/2012
  • CFS-0486
    SSI Screening Questionnaire
    PDF01/01/2011
  • CFS-0487
    Application for Title IV-E Payments/Medicaid
    PDF02/08/2013
  • PDF11/02/2009
  • CFS-0488
    Title IV-E Eligibility Summary
    DOC10/01/2010
  • PDF10/01/2010
  • CFS-0489
    Foster Parent Request for Consideration to Adopt
    PDF08/01/2009
  • PDF03/16/2011
  • PDF
  • CFS-0490
    Title IV-E Medicaid Eligibility Redetermination Summary
    PDF02/18/2010
  • CFS-0491
    Consent for Use of Funds and Resources
    PDF11/02/2009
  • CFS-0492
    ICAMA Medicaid Eligibility
    PDF06/01/2011
  • CFS-0493
    Title IV E Medicaid Redetermination
    DOC11/01/2011
  • CFS-0494
    Notification of Adoption for Medicaid
    PDF11/06/2009
  • PDF11/06/2009
  • CFS-0495
    Notification of Change
    PDF10/20/2009
  • PDF03/16/2011
  • CFS-0496
    Assessment for Income Assistance
    PDF08/01/2009
  • CFS-0509-A
    Recommendation To The Child Welfare Agency Review Board
    PDF08/01/2006
  • CFS-0509-B
    Request For Alternative Compliance or Policy Waiver
    PDF04/01/2008
  • CFS-0590
    Invitation to Family-Centered Meeting
    PDF08/01/2009
  • PDF03/16/2011
  • CFS-0590_Marshallese
    Invitation to Family-Centered Meeting (Marshallese)
    PDF08/01/2009
  • CFS-0590_Spanish
    Invitation to Family-Centered Meeting (Spanish)
    PDF08/01/2009
  • CFS-0592
    Financial/Medical Plan Interstate Compact on the Placement of Children
    PDF08/01/2009
  • CFS-0593
    DCFS Arkansas State Vehicle Safety Program
    PDF09/01/2007
  • PDF09/01/2007
  • CFS-0594
    Meal Voucher Authorization for "FEED THE KIDS" Program
    PDF02/23/2010
  • PDF03/16/2011
  • CFS-0595
    Meal Authorization Log for "FEED THE KIDS" Program
    PDF11/02/2009
  • CFS-0597
    Request to Open a Medicaid Account on an ICPC Case
    PDF11/13/2009
  • CFS-1136-A
    DCFS Employee Orientation Checklist Addendum
    PDF09/01/2008
  • CFS-1136
    DCFS Employee Orientation Checklist Addendum
    DOC09/01/2008
  • PDF09/01/2008
  • CFS-4330
    Child Welfare Student Stipend Agreement
    PDF04/13/2010
  • CFS-4331
    Educational Leave Contract - (Full-time/Part-time MSW Student)
    PDF11/02/2009
  • CFS-4332
    Child Welfare Student Stipend Application
    PDF10/01/2001
  • CFS-6010 Addendum - A
    Visitation Plan for New Case Plan
    DOC08/01/2006
  • CFS-6010 Addendum - B_1
    Independent Living Skills
    PDF11/02/2009
  • CFS-6013
    Application for Emergency Services
    PDF07/01/2006
  • PDF07/01/2006
  • CFS-6024
    Permanency Planning Court Report
    DOC08/01/2009
  • PDF03/16/2011
  • CFS-6091
    ICPC Parent / Relative Home Study Check List
    PDF08/01/2009
  • CFS-6092
    ICPC Home Study Request Check List
    PDF04/07/2010
  • CFS-6092-COVER LETTER
    ICPC Cover Letter
    PDF08/18/2010
  • CFS-6092-SOCIAL SUMMARY
    ICPC Social Summary
    PDF04/07/2010
  • CFS-6093
    ICPC Foster Care Home Study Check List
    PDF08/01/2009
  • CFS-6094
    ICPC Adoptive Home Study Check List
    PDF08/01/2009
  • CCRT
    Child Care Referral (Protective Services/Foster Care/Supportive Services)
    PDF05/21/2008
  • DHS-0081
    Consent for Release of Information
    PDF05/01/1994
  • DHS-0359
    DHS Systems Security Access Request
    DOC08/25/2009
  • DHS-4000
    Authorization to Disclose Health Information
    PDF11/01/2005
  • Drug Screen-Alcohol Test Authorization
    Drug Screen & Alcohol Test Authorization Form
    DOC08/01/2009
  • Foster Parent ITNA
    The Learning Needs Assessment Tool
    PDF01/03/2011
  • Foster Parent ITNA Tally Sheet
    The Learning Needs Assessment Tally Sheet
    PDF04/11/2011
  • ICPC-0030
    ICPC Supervision Report-30 day
    PDF07/07/2010
  • ICPC-0090
    ICPC Supervision Report-90 Day
    PDF07/07/2010
  • ICPC-0100A
    Interstate Compact Placement Request
    PDF08/01/2009
  • PDF03/16/2011
  • ICPC-0100B
    Interstate Compact Report on Child’s Placement Status
    PDF08/01/2009
  • PDF03/16/2011
  • ICPC-0101
    ICPC Sending State Priority Home Study Request
    PDF08/01/2009
  • Missing Receipt for P-Card
    Missing Receipt for P-Card Transaction Form
    PDF02/15/2011
  • NYTD Survey
    NYTD Survey
    PDF10/01/2010
  • Prospective Foster/Adoptive Parent Inquiry Letter
    Prospective Foster/Adoptive Parent Inquiry Letter
    DOC03/31/2011
  • Request for OST CHRIS Report
    Request for OST CHRIS Report
    PDF08/01/2009
  • Request for Service / Encumbrance (Non-Placement Services Only)
    Request for Service / Encumbrance (Non-Placement Services Only)
    XLS08/01/2009
  • SS-5-FS
    Application for a Social Security Card
    PDF04/11/2011
  • VR-7
    Birth Certificate Application
    PDF01/01/2009
  • VSP
    Arkansas State Vehicle Safety Program
    PDF09/01/2012
  • VSP-001
    Authorization to Operate State Vehicles and Private Vehicles on State Business
    PDF09/28/2010
  • VSP-002
    Authorization to Obtain Traffic Violation Record
    PDF09/28/2010