Court Reports
- DHS-0665 CFC Permanent Ward Court Report
Rev 04/12 - DHS-1280 CFC Initial Court Report Rev 05/12
- DHS-1281 CFC Updated Court Report Rev 07/12
- MDHHS-5964 Court Cover Letter
Rev 07/21
Determination of Care
- DHS-470-A, Assessment for Determination of Care for Children in Foster Care Ages 13+ Rev 08/11
- DHS-470 Assessment for Determination of Care for Children in Foster Care Ages 0-12 Rev 08/11
- DHS-668 Administrative Review Request for Determination of Care Denial
Rev 11/19
- DHS-1254, SED Waiver Foster Home Payment Request and Approval
Rev 03/19
- DHS-1945 Assessment for Determination of Care for Medically Fragile Children in Foster Care Rev 08/11
MiTEAM Practice Model & Family Team Meetings
- DHS-1104, Family Team Meeting Rev 05/15
- Family Team Meeting Protocol
Rev 04/13
- DHS-1104, Family Team Meeting Protocol - Spanish Rev 05/15
- DHS-1105, Family Team Meeting Report
Rev 09/18
- DHS-1105-SP, Family Team Meeting Activity Report - Spanish
Rev 06/17
- DHS-1107, A Caseworker's Guide to Pre-Meeting Discussions and Family Team Meetings Rev. 03-16
- DHS-1109, Family Team Meeting Invite Rev 09/11
- MDHHS-PUB-1160, A Family's Guide to Pre-Meeting Discussions and Family Team Meetings Rev 11/15
Foster Care Additional Forms
- DHS-30 Foster Parent Notification of Move Rev 05/17
- DHS-31 Foster Care Placement Decision Notice
Rev 07/21
- DHS-57 Foster Care Transitional Medicaid Rev 9/15
- DHS-67A Treatment Foster Care Parent-Agency Treatment Plan and Service Agreement Rev. 10/17
- DHS-197 - Home Study Outline Rev 05/15
- DHS-221, Medical Passport Rev 02/13
- DHS-348, Michigan Works! Workforce Innovation and Opportunity Act Agency Referral
Rev 04/18
- DHS-396 Residential Placement Exception Request Rev 7/12
- DHS-589 Recoupment Notice Rev 06/14
- DHS-594 Parental Placement of MCI Ward Request
Rev. 04-19
- DHS-602 Adoption Referral Rev 11/11
- DHS-637 Caseworker Visit Report Rev 8/08
- DHS-649 Foster Care/Juvenile Justice Child Fatality Notification Rev 06/15
- DHS-659, Foster Care Payment Authorization
Rev 09/19
- DHS-659-CCI Foster Care Payment Authorization CCI
Rev 09/19
- MDHHS-710 Clearance to Publish Information on AWOLP Youth
Rev 11/15
- DHS-715 Hearing Notice
Rev 03/19
- DHS-715 Hearing Notice (Spanish)
Rev 3/19
- DHS-715 Hearing Notice (Arabic)
Rev 3/19
- DHS-719-CWFS, Child Welfare Funding Specialist Tool
Rev 02/17
- DHS-786 Independent Living Plus Extension Request Rev 1/14
- DHS-790, Foster Parent Orientation Video Questions Rev 07/11
- DHS-867 - Notification to Court of Jurisdiction and Child's Lawyer Guardian Ad Litem Rev 05/15
- DHS-901-A, Semi-Annual Transition Plan Report, Youth Age 14-15
Rev 05/18
- DHS-901-B, Semi-Annual Transition Plan Report, Youth Age 16 and Older
Rev 02/19
- DHS-902, 90-Day Discharge Plan Report
Rev 02/19
- School Notification and Education Records Release - DHS-942
Rev 07/19
- DHS-945, Financial Aid Verification of Court/State Ward Status
- DHS-956, Youth Housing Referral
Rev 10/18
- DHS-1445, Child Support Confidential Locate Request
Rev 11/19
- DHS-1476 Early Discharge of MCI Ward Rev 05/17
- DHS-1555-CS, Authorization to Release Confidential Information Rev 05/17
- DHS-2351-X, Bridges Provider Enrollment/Change Request
Rev 07/18
- DHS-3198, Unauthorized Leave Notification Rev 05/15
- DHS 3198-A Unauthorized Leave Report to Court/Law Enforcement Rev 3/07
- DHS-3307 Placement Outline and Information Record
Rev 05/21
- DHS-3377 Clothing Inventory Checklist
Rev 8/19
- DHS-4527, Independent Living Agreement
Rev 9/17
- DHS-5307 Rights And Responsibilities For Children and Youth In Foster Care
Rev 05/19
- DHS-5307-SP Rights And Responsibilities For Children and Youth In Foster Care
Rev 5/19
- DHS-5307-AR Rights And Responsibilities For Children and Youth In Foster Care
Rev 5/19
- DHS-5331 Guidelines for Reasonable and Prudent Parent Standard
Rev. 02/17
- DHS-5333 Conversation Guide on Return from AWOLP Rev. 9/15
- MDHHS-5406 - Bed Hold Payment Request
Rev 09/19
- MDHHS-5406-IL, Bed Hold Payment Request for Independent Living Placements
Rev 01/21
- MDHHS-5523, Human Trafficking Screening Tool - Ongoing Cases
Rev 06/17
- MDHHS-5524, Human Trafficking Screening Tool - Closed Cases
Rev 06/17
- MDHHS-5594, Trauma Assessment Referral
Rev. 04/21a
- MDHHS-5748, Verification of Placement in Foster Care
Rev 07/18
- MDHHS-5822, Pre-Approval Request for Foster Parent Mileage Reimbursement for Visitation Travel Over 150 Miles Round Trip
Rev 08/19
- MDHHS-5829, Family Incentive Grant (FIG) and Unlicensed Relative Caregiver Funding
Rev 08/20
- MDHHS-5841, Waiver of Foster Care Payments in Lieu of Government Benefits
Rev 08/20
- MDHHS-5841-A, Waiver of Foster Care Payments in Lieu of Government Benefits
Rev 08/20
- MDHHS-5855, Orthodontic Payment Agreement
Rev 04/21
- MDHHS-5967, Overpayment Notification
Rev 07/21
For Forms Required for Interstate Compact, go to Interstate Compact Forms
Foster Care Supportive Visitation
- DHS-599, Foster Care Supportive Visitation and In-Home Parent Education Referral
Rev 10/20
- DHS-1469, Foster Care Supportive Visitation and In-Home Parent Education Visit Report Rev 10/15
- DHS-1470, Foster Care Supportive Visitation Termination Report
Rev 02/19
- DHS-1471, Foster Care Supportive Visitation and In-Home Parent Education Initial Assessment
Rev 02/19
- DHS-1472, Foster Care Supportive Visitation Service Agreement
Rev 010/20
- DHS-1473, Foster Care Supportive Visitation and In-Home Parent Education Weekly Progress Report
Rev 02/18
- DHS-1474 Foster Care Supportive Visitation and In-Home Parent Education Contract Compliance
Rev 10/20
- MDHHS-5465, Family Satisfaction Survey Foster Care Supportive Visitation Rev 10/16
- MDHHS-5466, Referring Worker Satisfaction Survey, Foster Care Supportive Visitation
Rev 10/20
- MDHHS-5716 - Foster Care Supportive Visitation and In-Home Parent Education Follow-Up Summary/Attempt
Rev 10/20
Permanency Goal Approval
- DHS-347 - Permanency Goal Approval Rev. 09/15
- DHS-569 Permanency Goal Support Agreement Rev. 08/15
- DHS-643 - Permanency Goal Review Rev. 08/15
Relative Search
- DHS-541 Relative Licensing Referral Agreement Rev 04/19
- DHS-987, Relative Documentation Rev. 05/15
- DHS-987-SP Relative Documentation Rev 05/15
- DHS-990 Relative Notification Letter
Rev 2/19
- DHS-990-SP Relative Notification Letter for CPS and Foster Care (Spanish)
Rev 2/19
- DHS-990-AR Relative Notification Letter (Arabic)
Rev 2/19
- MDHHS-991 Diligent Search Checklist Rev 05/16
- Relative Caregiving: What You Need to Know DHS-Pub-114 Rev 01/16
- MDHHS-5770, Relative Placement Safety Screen
Rev 09/21
Residential Care
- DHS-145 Family Assessment of Needs & Strengths Rev. 10/15
- DHS-365-A Children's Foster Care Residential Initial Service Plan (10-13 yrs)
Rev. 01/16
- DHS-365-B Children's Foster Care Residential Initial Service Plan (14 yrs and older)
Rev. 01/16
- DHS-365 Children's Foster Care Residential ISP (4-9 yrs) Rev. 12/15
- DHS-366-B Children's Foster Care Residential Updated Service Plan (14 yrs and older)
Rev. 2-16
- DHS-366-A Children's Foster Care Residential Updated Service Plan (10-13 yrs)
Rev. 12/15
- DHS-366 Children's Foster Care Residential Updated Service Plan (4-9 yrs) Rev. 12/15
- DHS-5335 Juvenile Justice Service Plan Addendum
Rev. 2/16
- MDHHS-5931, Residential Aftercare Report
Rev. 6/21
Residential Care-Juvenile Justice
- DHS-449 Juvenile Justice Reentry Care Coordination Referral
Rev. 01/20
- MDHHS-Pub-1243-AR, Preventing Sexual Assault - Youth Orientation Packet (Arabic)
Rev. 04/19
- MDHHS-Pub-1243, Preventing Sexual Assault - Youth Orientation Packet
Rev. 04/19
- MDHHS-Pub-1243-SP, Preventing Sexual Assault - Youth Orientation Packet (Spanish)
Rev. 04/19
- MDHHS-5520 Residential AWOLP and Escape Checklist
Rev. 03/18
- MDHHS-5605, Juvenile Justice Residential Youth Orientation Checklist
Rev. 11/17
- MDHHS-5606, Prison Rape Elimination Act (PREA) Screening Tool
Rev. 06/18
- MDHHS-5606-AR, Prison Rape Elimination Act (PREA) Screening Tool (Arabic)
Rev. 06/18
- MDHHS-5606-SP, Prison Rape Elimination Act (PREA) Screening Tool (Spanish)
Rev. 06/18
- MDHHS-5799-PREA, PREA Retaliation Monitoring Log
Rev. 05/19
- MDHHS-5809-PREA, Prison Rape Elimination Act (PREA) Investigation Tool
Rev. 08/19
- MDHHS-5810-PREA, Prison Rape Elimination Act (PREA) Investigation Report
Rev. 03/21
- MDHHS-5817-PREA, Annual Prison Rape Elimination Act (PREA) Staffing Plan Review
Rev. 08/19a
- MDHHS-5818-PREA, 30-Day Sexual Abuse Incident Review
Rev. 08/19
- MDHHS-5830-PREA, Prison Rape Elimination Act (PREA) Unannounced Rounds Log
Rev. 11/19
- MDHHS-5833-PREA, Prison Rape Elimination Act (PREA) Staffing Plan
Rev. 10/20
- MDHHS-5931, Residential Aftercare Report
Rev. 6/21
SDM Templates
- DHS-69 Foster Care Action Summary
Rev. 10/19
Supervisor Tools
- DHS-1154 Foster Care Supervisory Guide Rev 04/13
- DHS-1155 Foster Care Supervisory Tool Rev 07/13
Treatment Foster Care
- DHS-65A Treatment Foster Care Initial Service Plan Rev. 10/17
- DHS-66A Treatment Foster Care Updated Service Plan Rev. 10/17
- DHS-67A Treatment Foster Care Parent-Agency Treatment Plan and Service Agreement Rev. 10/17
- DHS-68A Treatment Foster Care Permanent Ward Service Plan Rev. 10/17
- DHS-974 Treatment Foster Care Extension Request Rev. 09/09
- DHS-975 Treatment Foster Care Exception Request Rev. 10/09
- DHS-976 Treatment Foster Care Denial of Referral Rev. 04/14
- DHS-977 Treatment Foster Care Referral Acceptance Rev. 12/08
- DHS-978 Treatment Foster Care Placement Request
Rev. 05/18
- DHS-979 Treatment Foster Care Discharge Report Rev. 03/09
Well Child Exams & Other Health Forms
- DHS-193, Foster Care Transitional Medicaid (FCTMA) Rev. 01/15
- Pub-268, Guidelines for Foster Parents and Relative Caregivers for Health Care and Behavioral/Mental Health Services
Rev. 08/18
- Pub-268-AR, Guidelines for Foster Parents and Relative Caregivers for Health Care and Behavioral/Mental Health Services
Rev. 08/18
- Pub-268-SP, Guidelines for Foster Parents and Relative Caregivers for Health Care and Behavioral/Mental Health Services
Rev. 08/18
- DHS-0439, Notice of Health Care Coverage for Former Foster Youth Extended to Age 26
Rev. 11/15
- DHS-580, Well Child Exam Infancy: 1 Week Visit Rev. 06/15
- DHS-579, Well Child Exam Infancy: 4 Weeks Rev. 04/16
- DHS-581, Well Child Exam Infancy: 4 Months Rev. 06/15
- DHS-0583, Well Child Exam Infancy: 2 Months Rev. 08/11
- DHS-1147 - Foster Care Youth Health Services Refusal
Rev. 05/19
- DHS-1556, Behavioral/Mental Health Exception
Rev. 08/17
- DHS-1631, Well Child Exam Early Childhood: 18 Months. Rev. 06/15
- DHS-1632 Well Child Exam Early Childhood 2 Years Rev. 06/15
- DHS-1633, Well Child Exam Early Childhood: 30 Months. Rev. 07/15
- DHS-1634 Well Child Exam Early Childhood 3 Years Rev. 04/16
- DHS-1635 Well Child Exam Early Childhood 5 Years Rev. 06/15
- DHS-0381 Well Child Exam Middle Childhood 6-10 Years Rev. 06/15
- DHS--1636, Well Child Exam Early Adolescence: 11-14 Years. Rev. 07/11
- DHS-1637 Well Child Exam Early Adolescence: 15 - 18 Years Rev. 08/15
- DHS-1638, Well Child Exam Early Childhood: 9 Months Rev. 07/11
- DHS-1639, Well Child Exam Early Childhood: 12 Months Rev. 08/11
- DHS-1640, Well Child Exam Early Childhood: 15 Months Rev. 06/15
- DHS-1641, Well Child Exam Infancy: 6 Months Rev. 06/15
- DHS-1642, Well Child Exam Early Childhood: 4 Years Rev. 08/11
- DHS-1643, Psychotropic Medication Informed Consent
Rev. 03/21
- DHS-1664, Youth Dental Exam
Rev 07/18
- MDHHS-5338, Foster Care Well Child Exam/EPSDT Appointment Verification
Rev. 12-15
Young Adult Voluntary Foster Care
- DHS-38, Verification of Employment Rev. 12/07
- DHS-54A, Medical Needs Rev. 10/08
- DHS-333, YAVFC Poster Rev. 7/13
- DHS-650-YA, Young Adult Extension Unit Checklist
Rev. 09/19
- DHS-1295, Young Adult Monthly Visit Report
Rev. 12/18
- DHS-1297, Young Adult Voluntary Foster Care Agreement
Rev. 03/20
- DHS-1297-SP, Young Adult Voluntary Foster Care Agreement (Spanish)
Rev. 03/20
- DHS-1301-YA, Young Adult Voluntary Foster Care Case Denial/Closure Notice
Rev. 01/19
- DHS-1302, Young Adult Voluntary Foster Care Case Closure Request Rev. 05/17
- DHS-3380, Verification of Student Information Rev. 10/12
- MDHHS-5778, Young Adult Voluntary Foster Care Verification of Eligibility
Rev. 02/20
