F.C.A.§§1089, 1089-A 1 Form PH-5
(Permanency Hearing Order)
6/2016
New York State Family Court
County of ______________
Hearing Date: ____________
PRESENT:
Hon.
Judge
...........................................................................
In the Matter of
Docket No.
PERMANENCY HEARING
CIN # ORDER
A Child or Children Under 21 Years of Age
Alleged to be “Abused “Neglected “ Voluntarily Placed
“ Destitute
Respondent(s)
...........................................................................
NOTICE: IF YOUR CHILD(REN) STAY IN FOSTER CARE FOR 15 OF THE MOST
RECENT 22 MONTHS, THE AGENCY MAY BE REQUIRED BY LAW TO FILE A
PETITION TO TERMINATE YOUR PARENTAL RIGHTS AND MAY FILE
BEFORE THE END OF THE 15-MONTH PERIOD. IF THE PETITION IS
GRANTED, YOU MAY LOSE YOUR RIGHTS TO YOUR CHILD(REN) AND
YOUR CHILD(REN) MAY BE ADOPTED WITHOUT YOUR CONSENT.
THE NEXT COURT DATE IS [date/time]: ____________________
THE NEXT PERMANENCY HEARING SHALL BE HELD ON [date/time]
:________________
An order having been issued directing that the child(ren) be placed or removed from the parent or
person legally responsible for the child(ren) ; and
“ This hearing having been heard jointly with the “ custody “ guardianship petition,
Docket #: __________________________ ;
And the position and information provided by the local department of social services, as well as that
of the child(ren) and others appearing before the Court, having been considered by the Court;
And the following child(ren) having [check applicable box(es)]:
Child
: “ appeared “ participated as follows [specify]:
“ did not participate
Child
: “ appeared “ participated as follows [specify]:
“ did not participate
Child
: “ appeared “ participated as follows [specify]:
“ did not participate
1 Note: If permanency planning goals, findings or other provisions of this order differ for different children, a separate
permanency order for each child should be issued.
PH-5 Page 2
Reasonable Efforts Determination
The Court makes the following findings regarding reasonable efforts to implement the permanency
hearing goal in place at the commencement of this hearing:
Reasonable efforts to make and finalize the permanency planning goal of [return to parent, adoption,
guardianship, permanent placement with a fit and willing relative, or placement in another planned
permanent living arrangement][specify]:_____________________________________
“ were made as follows [specify reasonable efforts, including consideration of out-of-State
resources:] ____________________________________________________________________
______________________________________________________________________________
“ were not made [specify]: _______________________________________________________
_____________________________________________________________________________
“ The permanency goal is reunification and reasonable efforts were not made,
but the lack of efforts was
appropriate
because of a prior judicial finding that the authorized agency was not required to make
reasonable efforts to reunify the child(ren) with the parent(s).
This determination is based upon the following information [check applicable box(es)]:
“ Permanency report, sworn to on [specify date]: __________________________________________
“ Case record, dated [specify]: ________________________________________________________
“ Service plan, dated [specify]: ________________________________________________________
“ Probation Department report, dated [specify]: ___________________________________________
“ Mental health evaluation, dated [specify]: ______________________________________________
“ The report of [specify]: ____________________________ , dated: _____________________________
“ Testimony of [specify]: ____________________________, (on _______________________________)
“ Other [specify]:
______________________________________________________________
Findings and Orders
THE COURT ORDERS that:
“
PLACEMENT OR TEMPORARY REMOVAL IS TERMINATED :
“ And the child(ren) (is) (are) discharged to the custody of the respondent(s)
______________________
“ Immediately or on [specify date]: ______________________________
“ without supervision “ with supervision of a child protective agency, social services official,
or duly authorized agency until:________________
“ upon the following terms and conditions: ________________________________________
______________________________________________________________________________
“ THE CHILD(REN) IS/ARE PLACED OR CONTINUE(S) TO BE PLACED
in the custody of the
Commissioner of Social Services until the completion of the next permanency hearing or pending further
orders of this court. The Court finds that continued placement or temporary removal of the child(ren) is
required due to best interests and safety needs of the child(ren) and that the child(ren) would be at risk of
further abuse or neglect if returned to the parent/respondent.
PH-5 Page 3
“ [Applicable if placement is for residence with a relative or other suitable person]: And the
child(ren) shall reside with [specify relative or other suitable person ]
2:____________________
“ And during the period of such placement, respondent(s)[specify]:
_________________________ shall remain under the supervision of a child protective agency,
social services official, or duly authorized agency
“ upon the following terms and conditions:____________________________________
________________________________________________________________________
“ THE CHILD(REN) IS/ARE DIRECTLY PLACED OR CONTINUE(S) TO BE DIRECTLY
PLACED pursuant to Family Court Act §1055(a)(ii), with [specify relative or suitable
person]:_____________________ until the completion of the next permanency hearing or further orders
of this court. The Court finds that continued placement or temporary removal of the child(ren) is required
due to best interests and safety needs of the child(ren) and that the child(ren) would be at risk of further
abuse or neglect if returned to the parent/respondent.
“ THE CHILD(REN) IS/ARE RELEASED,
pursuant to Family Court Act §1054, to [specify non-
respondent parent, legal custodian 3 or guardian]:_____________________ until [specify date]: 4
or further orders of this court.
ORDERED that, during the period of release, the individual to whom the child has been
released under this Order may [check applicable box(es)]:
enroll the child in public school in the applicable school district and, upon verifying
the Order and that the individual resides within the district, such district shall enroll the child;
enroll the child in their employer-based health insurance plan with the same rights as a
child for whom the individual is the legal guardian or custodian; and
make decisions and provide any necessary consents regarding the child’s:
protection education care and control physical custody health and medical needs, provided
that this Order does not limit any rights of the child to consent to medical care under applicable laws.
REQUIRED WHERE CHILD(REN) ARE DIRECTLY PLACED OR RELEASED :
[Required Findings regarding all releases
of child(ren) to Respondent(s), Non-respondent parents
or legal custodians or guardians and orders of direct placement
with relative(s) or suitable
person(s); check applicable box(es)]
And the Court having searched the statewide registry of orders of protection, the sex offender
2 The relative or suitable person must be approved or certified as a foster parent.
3 “Legal custodian” refers to an individual with an order of custody issued prior to, and separate from, the child
protective proceeding. A release to such an individual is distinguished from a child placed in the custody of an individual
pursuant to an order of custody issued under Article 6 and section 1055-b or 1089-a of the Family Court Act. Such a custody
order results in the termination of all orders under Article 10 of the Family Court Act, would not be deemed a “release” of the
child and would thus not be the subject of a permanency hearing.
4 The period of release may not exceed one year plus an extension for good cause so that the total period of the release
and extension thereof may not exceed two years.
PH-5 Page 4
registry and the Family Court’s warrant and child protective records, and having notified the attorneys
for the parties and for the child [check if applicable]: A and the following self-represented party or
parties [specify]: of the results of these searches;
And the Court having considered and relied upon the following results of these searches in
making this decision [specify; if no results found, so indicate]:
ORDERED that, during the pendency of the placement or release, the relative or
suitable person with whom the child(ren) has/have been placed or the non-respondent
parent, legal custodian or guardian to whom the child(ren) has/have been released ,
who
has consented to the jurisdiction of this Court with respect to the child,
shall cooperate
with respect to making the child(ren) available for court-ordered visitation with
respondents, siblings and others, appointments with the child(ren)’s) attorneys and
clinicians and other individuals or programs providing services to the children, visits
(including home visits) by the child protective agency and the following additional
direction(s) [specify]:
ORDERED that during the period of such placement, Respondent(s)[specify]:
are to remain under the supervision of a child protective agency, social services
official, or duly authorized agency:
upon the following terms and conditions to be met by Respondent(s) [specify]:
upon the terms and conditions specified in the annexed Family Treatment Court
agreement, dated [specify]:
upon the performance of the following supervisory actions by the child
protective agency, social services official or duly authorized agency [specify]:
ORDERED that the child protective agency, social services official or duly
authorized agency shall provide the following services or assistance to the
child(ren) and their family, pursuant to section 1015-a of the Family Court Act
[specify]:
5
“ PERMANENCY HEARING HELD JOINTLY WITH CUSTODY OR GUARDIANSHIP
HEARING, PURSUANT TO FAMILY COURT ACT §1089-a
:
[Applicable to custody with non-respondent parents
]:
The Court having adjudged that custody of the following child(ren)[specify]:
with the following non-respondent parent [specify]: is in the best interests
of the child(ren) in accordance with Article 6 of the Family Court Act and Domestic
5 Services and assistance ordered under F.C.A. §1015-a must be authorized under the comprehensive annual services
program plan in effect.
PH-5 Page 5
Relations Law §240, ORDERED that such non-respondent parent is
granted custody of
[specify child(ren)]:_______________________________ pursuant to an Order of custody
granted on Docket #____________________, dated: _______________, thereby terminating the
jurisdiction of this Court over this permanency proceeding and terminating custody with the local
Commissioner of Social Services.
OR
[Applicable to custody with Respondent(s), relative(s) or suitable persons; guardianship
with relative(s) or suitable person(s)]:
The Court having adjudged that [Note: Findings are REQUIRED under (i) and (ii), below]:
(i) [Check one of the following boxes]:
all parties, including the attorney of the child(ren) and any foster parent who has had
custody of the child(ren) in excess of one year, have consented to such custody or
guardianship;
OR
the following parent(s)[specify]: have not consented but this
Court has found extraordinary circumstances supporting custody or guardianship;
AND
(ii) custody of the following child(ren)[specify]: with [specify
respondent parent(s)]:
will provide a safe and permanent home for the child(ren) and the safety of the child(ren)
will not be jeopardized if the respondent(s) are no longer under the jurisdiction of this
Court on this petition and are not receiving services or supervision;
OR
custody guardianship of the following child(ren)[specify]:
with by [specify relative(s) or suitable person(s)]:
will provide a safe and permanent home for the child(ren) and the safety of the child(ren)
will not be jeopardized if the respondent(s) are no longer under the jurisdiction of this
Court on this petition and are not receiving services or supervision;
AND
IT IS, THEREFORE ORDERED that [specify Respondent, relative(s) or suitable
person(s)]: is/are granted custody of [specify child(ren)]:
pursuant to an Order granted on Docket # [specify]: , dated [specify]:
thereby terminating the jurisdiction of this Court over this proceeding;
OR
IT IS, THEREFORE ORDERED that [specify relative(s) or suitable person(s)]:
is/are appointed guardian(s) of [specify child(ren)]:
pursuant to an Order granted on Docket # [specify]: , dated [specify]:
thereby terminating the jurisdiction of this Court over this proceeding;
AND IT IS FURTHER ORDERED that the following local department of social
services [specify]: and the following attorney for the
child(ren)[specify]: shall be notified and shall be made parties to
any subsequent proceedings for modification, enforcement or termination of the Order
granted on such Docket #;
PH-5 Page 6
AND THE COURT FURTHER ORDERS:
FINAL DISCHARGE
“ The Commissioner of Social Services is authorized to FINALLY discharge the child(ren)
from the Commissioner’s care to the parent without further court hearing, provided that written
notice is provided to the Court and attorney for the child(ren) not less than 10 days in advance of
the discharge.
TRIAL DISCHARGE: RESTRICTIONS AND EXTENSIONS
The Commissioner of Social Services 6
may discharge the child(ren) on a trial basis or continue such a discharge until the
earlier of the completion of the next Permanency Hearing or further Order of the Court
“ may not discharge the child(ren) on a trial basis to the physical custody of respondent(s):
___________________________________________________________________________
“ may only discharge the child(ren) on a trial basis to the physical custody of respondent(s)
______________________________upon the following event(s) or condition(s):_____________
______________________________________________________________________________
“ may not discharge the child(ren) on a trial basis to another planned permanent living
arrangement;
“ may only discharge the child(ren) on a trial basis to the following planned permanent
living arrangement [specify, including significant connections to an adult willing to
be a permanent resource]:________________________upon the following event(s) or
condition(s):__________________________________________________________
; (and it is further)
[Applicable to youth 18 and over who will be discharged on a trial basis with their consent]:
“ The Commissioner of Social Services
shall discharge the youth on a trial basis
shall continue the discharge of the youth
may continue or extend the trial discharge of the youth
to another planned permanent living arrangement other [specify]:
until the earlier of the next permanency hearing, further Order of the Court OR
21
st birthday(s) of the youth.
Youth 18 and over discharged on a trial basis shall inform the local department of social
services of any change in mailing address and contact information.
“ ABSCONDING [Required if child(ren) in placement]:
6 Note: during a period of trial discharge, legal care and custody remains with the Commissioner and permanency
hearings must be held. Youth 18 years of age or older must consent to any trial discharge.
PH-5 Page 7
If the child(ren) abscond(s) from the above-named custodial person or facility, written notice shall be
given within 48 hours to the Clerk of Court by the custodial person or by an authorized representative of
the facility, stating the name of the child(ren), the docket number of this proceeding, and the date on
which the child(ren) ran away.
“ ORDER OF PROTECTION
:
[Specify respondent(s) or other person(s) before the court]:__________________________________
(is)(are) required to comply with the terms and conditions specified in the order of protection, issued
pursuant to Family Court Act §1056, annexed to this order and made a part thereof.
Permanency Goal
The Petitioner’s permanency goal for the child(ren) “ which has already been achieved or “ is to be
achieved by: “ the next permanency hearing date or “ [specify date]: __________________ is
“ approved “ modified as follows:
“ reunification with the “ parent(s) “ other person(s) legally responsible for the child(ren)’s care
“ placement for adoption, including consideration of interstate options
“ upon filing a petition to terminate parental rights within 90 days, unless a surrender has
been executed;
“ pending a parental rights termination petition already filed;
“ upon judicial approval of surrender instrument;
“ referral for legal guardianship by:________________________________________________
“ permanent placement with the following fit and willing relative:________________________
“ [Applicable ONLY to children 16 years of age or older]: permanent placement in the
following alternative planned living arrangement: _____________
Required for all children 16 years of age or older with Alternative Planned Permanent Living
Arrangement (APPLA) Goals [check applicable box(es) in ¶¶a - f ]:
Required for permanency hearing involving a child(ren) 16 years of age or older with Alternative
Planned Permanent Living Arrangement (APPLA) Goals [check applicable box(es) in ¶¶a - f ]:
a. Evidence has been provided to the Court, indicating compelling reason(s) that it would
not be in the child(ren)’s best interests to return home, be referred for termination of parental rights and
adoption, placed with a fit and willing relative, or placed with a legal guardian. These reasons are as
follows [specify compelling reason(s)]:
b. Evidence has been provided to the Court, indicating that intensive, ongoing, and, as of the
date of this Order, unsuccessful efforts were made to return the child(ren) home or secure a placement
for the child(ren) with a fit and willing relative, including adult siblings, a legal guardian, or an
adoptive parent, including through efforts that utilize search technology including social media to
find biological family members of the child(ren).
c. Evidence has has not been provided to the Court that a “reasonable and prudent
parent” standard of care has been applied to the child(ren) in the facility or home in which he or she
resides;
PH-5 Page 8
d. Evidence has has not been provided to the Court that the child(ren) has/have been
provided with regular, ongoing opportunities to engage in age or developmentally appropriate activities
and has been consulted in an age-appropriate manner about the opportunities to participate in such
activities;
e. The Court inquired directly of the child(ren) regarding the permanency plan.
f. The following individual, with whom the child(ren) has/have a significant connection, is
willing and is designated to be the child(ren)’s permanency resource [specify]:
g. The Court has determined that APPLA with a significant connection to an adult willing to be a
permanency resource for the child(ren) is the best permanency plan for the child(ren) because [specify]:
[Applicable in all cases]:
Any modifications of the Permanency Goal shall be given by Petitioner
to the parent(s) or other person(s) legally responsible for the child(ren)’s care, with a copy of this Order.
Future Reasonable Efforts Ordered by the Court
“ The following reasonable efforts shall be made to make and finalize the child(ren)’s goal of [specify
goal and describe efforts]:________________________________________________________________
“ Petitioner shall plan concurrently for___________________________________________________
EDUCATIONAL PLAN
(child(ren) remaining in out of home care):
The “ educational “ vocational components of the child(ren’s) permanency plan “ are appropriate “
should be modified as follows:___________________________________________________________
____________________________________________________________________________________
The Petitioner shall take the following steps and/or provide the following services for the education, health
and well-being of the child(ren): __________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
STRENGTHENING PARENTAL RELATIONSHIP
:
“ The local social services district or authorized agency shall undertake diligent efforts to encourage and
strengthen the parental relationship, including encouraging and facilitating visitation with the child(ren) by
the parent or other person legally responsible, and encourage and facilitate visitation with the child(ren) by
any non-custodial parent or grandparent who has obtained an order pursuant to F.C.A. §1081 and by the
child(ren)’s siblings. Such efforts shall include, but are not limited to, the following [specify]:_______
___________________________________________________________________________________
VISITATION
(child(ren) remaining in out of home care):
“ The Petitioner shall provide the parent or other person(s) legally responsible for the child(ren)’s care
with visits with the child(ren) as follows:___________________________________________________
PH-5 Page 9
____________________________________________________________________________________
“ The Petitioner shall provide the following sibling(s):________________________________________
with visits with the child(ren) as follows: ___________________________________________________
____________________________________________________________________________________
“ Visits with the “ parent or other person(s) legally responsible for the child(ren)’s care “ siblings shall
be limited as follows [specify]: ___________________________________________________________
____________________________________________________________________________________
TERMINATION OF PARENTAL RIGHTS PETITION
(Goal - Adoption):
“ Unless a surrender has been executed, the Commissioner of Social Services or authorized agency is
directed to file termination of parental rights petitions regarding the following child(ren):
___________________ against the following respondent(s): __________________________________
within 90 days of the date of this order or as directed as follows: _______________________________
TRANSITIONAL SERVICES
(Child(ren) will be 14 or older prior to the next permanency hearing)
“ The Court FINDS that the following services and assistance are needed to assist the child(ren) in
learning independent living skills to make the transition from foster care to successful adulthood
and the
court ORDERS the Petitioner is to provide the following services and assistance to assist the child(ren)
in
learning independent living skills to make the transition from foster care to successful adulthood
[specify]:
And it is further ORDERED that the permanency plan developed for the child(ren) in
foster care and any revision or addition to the plan, shall be developed in consultation with the child(ren).
The child(ren) may select up to two members of the child(ren)'s permanency planning team to participate,
one of whom may be designated to be the child(ren)'s advisor and, as necessary, advocate, with respect to
the application of the reasonable and prudent parent standard to the child(ren); provided, however, that
such members may not be foster parents of, or case workers, case planners or case managers for, the
child(ren) and that the local commissioner of social services with custody of the child(ren) may reject an
individual so selected by the child(ren) if such local commissioner has good cause to believe that the
individual would not act in the best interests of the child(ren);
OR
“ The Court finds that NO services or assistance are needed to assist the child(ren) to assist the child(ren)
in learning independent living skills to make the transition from foster care to successful adulthood .
CONSENT - CHILD(REN) 18 OR OLDER
(child(ren) remaining in out of home care):
The child(ren) “has/have consented “has/have not consented to remain in foster care;
OUT OF STATE PLACEMENT
(child(ren) remaining in out of home care):
“ The court finds that placement outside New York State is appropriate, necessary, and in the child(ren)’s
best interests, and the court orders that the placement of the child(ren)
at:_____________________________ is continued until completion of the next permanency hearing .
“ The court finds that placement outside New York State is NOT appropriate, necessary and in the
child(ren)’s best interests, and the child(ren) shall be returned to New York State to be:
PH-5 Page 10
“ placed with [specify, if individual ]: ___________________________________________________ .
“ discharged to [specify, if individual]:___________________________________________________ .
PROGRESS REPORTS AND NOTICES
:
“ Petitioner shall make a progress report to the Court, the parties and the attorney for the child(ren) on the
implementation of this order as follows [specify date and/or frequency]: __________________________
“ If the above permanency goal for the above-named child(ren) is changed, notice shall be provided to the
Court, the parties and the attorney for the child(ren) forthwith.
[Applicable to children released to non-respondent parent or legal custodian or guardian, pursuant
to Family Court Act §1054]:
Petitioner shall report to the Court, the parties and the attorney for the child [check applicable box(es)]:
not later than 60 days prior to the termination of the order, unless a petition for extension of the
period of supervision of Respondent and/or release of the child has been filed;
7 and
during the period of supervision and/or release, Petitioner shall submit progress reports to the
Court, the parties and the attorney for the child as follows [specify]:
DUTY TO DISCLOSE CHANGES IN MAILING ADDRESS :
The respondent parent(s) or other person(s) legally responsible for the child(ren)’s care, as well as any
youth 18 years of age or older who are discharged on a trial basis, are required to notify the local
department of social services or agency of any change of mailing address and contact information.
PLANNING CONFERENCES
(child(ren) remaining in out of home care):
The parent(s) or other person(s) legally responsible for the child(ren)’s care shall be notified of the
planning conference(s) to be held and of (his)(her)right to attend such conference(s) with counsel or other
person.
NOTICES AND PERMANENCY HEARING REPORTS
(child(ren) remaining in out of home care):
Petitioner shall transmit notice of the hearing and a permanency report NO LATER THAN 14 DAYS IN
ADVANCE OF the permanency hearing date directed on the face of this Order to the respondent and non-
respondent parent(s), other parties, attorneys, the attorney for the child(ren) and any pre-adoptive parents or
relatives providing care to the child(ren) and shall also transmit notice of the hearing to former foster
parent(s) who have had care of the child(ren) in excess of 12 months, unless otherwise directed by this Court..
FURTHER ORDERS
:
“ It is further ORDERED
ENTER
Judge of the Family Court
7 Unless the Court determines that facts and circumstances do not warrant a report, a report 60 days prior to the
expiration of the order is required where the extension is issued on consent of the parties and the attorney for the child and may
be ordered in the Court’s discretion in other cases. See Family Court Act §§1054(d); 1057(c).
PH-5 Page 11
Dated: ___________
PURSUANT TO SECTION 1113 OF THE FAMILY COURT ACT, AN APPEAL FROM THIS ORDER
MUST BE TAKEN WITHIN 30 DAYS OF RECEIPT OF THE ORDER BY APPELLANT IN COURT,
35 DAYS FROM THE DATE OF MAILING OF THE ORDER TO APPELLANT BY THE CLERK OF
COURT, OR 30 DAYS AFTER SERVICE BY A PARTY OR THE ATTORNEY FOR THE CHILD
UPON THE APPELLANT, WHICHEVER IS EARLIEST.
Check applicable box:
“ Order mailed on [specify date(s) and to whom mailed ]:___________________________
“ Order received in court on [specify date(s) and to whom given]:_____________________
