Fill and Sign the Foster Care Forms Social Services Law Section 358 a

Soc. Serv. Law §§ 358-a, 384-a, 384-c Form 358-a-5 (Order of Disposition - Petition for Approval of an Instrument) 8/2010 At a term of the Family Court of then State of New York, held in and for the County of , at , New York , on P R E S E N T: Hon. Judge ____________________________________________ In the Matter of the Application for Docket No. Approval of an Instrument concerning ORDER OF DISPOSITION-- PETITION FOR APPROVAL CIN # OF AN INSTRUMENT Pursuant to Section 358-a of the Social Services Law_____________________________________________ NOTICE: IF YOUR CHILD STAYS 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 AND YOUR CHILD MAY BE ADOPTED WITHOUT YOUR CONSENT. THE NEXT PERMANENCY HEARING SHALL BE HELD ON [SPECIFY DATE/TIME ]:1 The Petition of an authorized official of the G Department of Social Services for [specify]: County, G New York City Administration for Children’s Services, dated [specify]: , having been filed with the Court requesting approval of an instrument transferring custody and care of the child to the agency; And the following person(s) having been duly served with notice of this proceeding and having been given an opportunity to be heard [check applicable boxes]:“ Parent [specify]:: having “ appeared “ with counsel “ without counsel “ waived counsel “ not appeared; “ Parent [specify]:: having “ appeared “ with counsel “ without counsel “ waived counsel “ not appeared; “ Guardian(s) [specify]: Appeared: “ yes “ no “ with counsel “ without counsel S p ecify a d ate certain no t m o re than eight m o nths fro m the d ate o f rem o val. If the child has a sib ling o r 1 half-sib ling rem o ved fro m the ho m e, who se p erm anenc y hearing is sched uled b efo re this C o urt, the d ate certain shall b e the sam e as the d ate certain fo r the sib li ng’s o r half-sib ling’s p erm anency hearing, unless t he sib ling o r half- sib ling w as rem o ved o n a juvenile d elinq uency o r P I N S p etitio n o r unless he o r she has p erm anency hearing shall b e cancelled . Form 358-a-5 Page 2 “ Petitioner Appeared: “ yes “ no “ Prospective adoptive parent(s) [specify]: Appeared: “ yes “ no “ Relatives providing care for the child [specify]: Appeared: “ yes “ no “ Other [specify]: Appeared: “ yes “ no “ with counsel “ without counsel; And the “ parent(s) [specify]: “ guardian(s)[specify]: having by written instrument “ consented to the jurisdiction of this Court and “ waived service of the petition and notice of proceeding, and the Court having dispensed with such service [check box(es) if applicable]; And an attorney having been appointed and having appeared to represent the child; [Required in cases involving Native-American children; check if applicable ]: “ And the following having been duly notified [check applicable box(es)]: “ parent/custodian “ tribe/nation “ United States Secretary of the Interior; And the tribe/nation having: “ appeared and participated as a party; “ appeared and declined to assume jurisdiction; “ appeared and requested transfer of jurisdiction; “ not appeared; [Note: Required; judicial findings must be made pursuant to I and, if petition is GRANTED, II , III and, if applicable, IV]: And the matter having duly come on for a hearing before this Court, the Court, after hearing the proof and testimony offered in relation to the case, finds and determines that: I. Criteria for Approval of Placement Instrument [Check applicable box(es) in A, B and C, below]: A. The “ parent(s) [specify]: “ guardian(s) [specify]: “ did “ did not execute such instrument knowingly and voluntarily; and B. The “ parent(s) [specify]: “ guardian(s) [specify]: “ would “ would not be able to make adequate provision for the care, maintenance and supervision of the child in the home; and C. The requirements of Social Services Law §384-a have been satisfied (except [specify] ). II. “Best Interests” and “Reasonable Efforts” Findings [check applicable boxes and provide case- specific reasons in A, B and C, below] A. Continuation of the child in, or return of the child to, the child's home would be contrary to the best interests of the child because [specify facts and reasons]: This determination is supported by the following information [check applicable box(es)]: G Case Record, dated [specify]: G Service Plan, dated [specify]: G The report of [specify]: , dated [specify]: Form 358-a-5 Page 3 G Other [specify]: B. Reasonable efforts, where appropriate, to prevent or eliminate the need for placement, and, if the child was removed prior to the date of the hearing, to return the child home safely [check applicable box and state reasons as indicated]: G were made as follows [specify]: G were not made but the lack of efforts was appropriate [check all applicable boxes]: G because of a prior judicial finding that the authorized agency was not required to make reasonable efforts to reunify the child with the G parent(s) G guardian(s) [specify date of finding]: G because [specify other reasons]: G were not made. This determination is supported by the following information [check applicable box(es)]: G Case Record, dated [specify]: G Service Plan, dated [specify]: G The report of [specify]: , dated [specify]: G Other [specify]: C . [REQUIRED in cases in which the child’s permanency plan is adoption, guardianship or permanent living arrangement other than reunification]: Reasonable efforts to make and finalize the permanency plan of [specify]: G were made as follows [specify]: G were not made. This determination is supported by the following information [check applicable box(es)]: G Case Record, dated [specify]: G Service Plan, dated [specify]: G The report of [specify]: , dated [specify]: G Other [specify]: III. Findings Regarding Relatives and Siblings [Required; check applicable boxes in A and B, below]: A. Relatives: Based upon the investigation conducted by the Commissioner of Social Services, [Check applicable box(es]:G The following person is a suitable person related to the child with whom such child may appropriately reside [specify]: Such person: G seeks approval as a foster parent in order to provide care for the child; G wishes to provide care and custody for the child without foster care subsidy at this time. “ may be a resource but not yet determined whether as foster parent or custodian. G There is no suitable person related to the child with whom the child may appropriately reside. B. Siblings: Based upon the investigation conducted by the Commissioner of Social Services, [Check applicable box(es]:G The following sibling(s) or half-sibling(s) are in the care and custody of the Commissioner of Form 358-a-5 Page 4 Social Services of [specify]: County [specify]: G Placement of the child with the following sibling(s) or half-sibling(s) [specify]: would be appropriate and in the children’s best interests [specify]: G Placement of the child with the following sibling(s) or half-sibling(s) [specify]: would not be in the child’s best interests based upon the following facts and for the following reasons [specify]: G The following is the plan for visiting and communication with the sibling(s) or half- sibling(s)[specify]: G Visiting and communication with the sibling(s) or half-sibling(s) would be contrary to the children’s best interests based upon the following facts and for the following reasons [specify]:[specify]: G The child has no siblings or half-siblings. G The child has the following siblings or half-siblings [specify]: who are in the custody of [specify]: IV. Transitional Services [Required where child is 14 years of age and older]: “ The services, if any, needed to assist the child to make the transition from foster care to independent living are [specify]: NOW, therefore, it is hereby [check applicable box(es)]: A. Disposition of Petition [Required; check applicable box] “ ORDERED that the petition is GRANTED and the instrument dated [specify]: and executed by [specify]: is approved and the custody and care of the child is hereby transferred to the Petitioner ; OR “ ORDERED that the petition is DISMISSED and the child is discharged. and must be returned forthwith to [specify]: ; (and it is further) B. Reasonable Efforts [Applicable where petition granted] [Applicable where the child’s permanency plan is reunification with the parent or guardian]: “ ORDERED that following reasonable efforts shall be made to make and finalize the child’s permanency plan of reunification [specify]: “ ORDERED that [specify]: , “ a social services official “ a duly authorized agency, undertake diligent efforts to encourage and strengthen the parental relationship, including, but not limited to, the following [specify]: ; (and it is further) [Applicable where the child’s permanency plan is adoption, guardianship or permanent living arrangement other than reunification]: Form 358-a-5 Page 5 “ ORDERED that following reasonable efforts shall be made to make and finalize the child’s permanency plan of [specify permanency plan and describe efforts]: ; (and it is further) C. Relatives, Suitable Persons, Siblings and Half-siblings [Applicable if petition granted] : “ ORDERED that the Commissioner of Social Services investigate [specify]: as a relative or other suitable person with whom the child may reside; (and it is further) “ ORDERED that the Commissioner of Social Services investigate placement of the child with the following siblings or half-siblings [specify]: ; (and it is further) D. Visitation with Parents, Guardians, Grandparents, Siblings and Half-siblings [Required where petition granted] 2 “ ORDERED that Petitioner shall provide the “ parent(s) “ (guardian(s) with visitation with the child as follows [describe visitation plan]: ;(and it is further) [Applicable where Petitioner or the attorney for the child opposed incorporation of a visitation order regarding non-custodial parents or grandparents into the placement instrument]: “ ORDERED that the application of “ Petitioner “ attorney for the child for the visitation order regarding the following non-custodial parents or grandparents [specify]: not to be incorporated into the placement instrument is hereby “ granted “ denied; and the visitation order is “ incorporated “ not incorporated “ modified as follows [specify]: ; (and it is further) “ ORDERED that Petitioner shall provide the following sibling(s) or half-sibling(s) of the child with visitation with the child as follows [describe visitation plan]: ; (and it is further) E. Notice of Planning Conferences, Service of Order and Service Plan [Required in all cases in which the petition is granted] “ ORDERED that the “ parent(s) “(guardian(s) be notified of the planning conference or conferences to be held with respect to the child, of the parent(s)’ or guardian(s)’ right to attend such conference(s) and of the right to be accompanied at such conference(s) by counsel or other person; or (and it is further) “ ORDERED that the Petitioner shall serve a copy of this Order and service plan “ personally “ by certified mail upon the “ parent(s) “(guardian(s) who executed the T he visiting p lan w ith the p arents o r guard ians m us t b e d escrib ed in the o rd er p ursuant to S o cial S ervices 2 L aw § 3 5 8 -a(3 )(e). If the P etitio ner o r atto rney fo r the child o p p o se inco rp o ratio n o f a visiting o rd er regard ing a no n- custo d ial p arent o r grand p arent, this o rd er m ust co ntain a d eterm inatio n o f that ap p licatio n. S ee S o cial S ervices L aw § 3 5 8 -a(1 0 )(b ). F urther, this o rd er m ay co ntain a d irectio n to the P etitio ner regard ing the find ings rend ered w ith resp ect to the child ’s p lacem ent, visiting and co m m unicatio n w ith sib lings o r half-sib lings. S ee S o cial S ervices L aw § 3 5 8 -a(1 1 ). Form 358-a-5 Page 6 aforesaid instrument. Such service shall be made within [specify]: days from the date of this order, and shall be accompanied by a notice of the terms and conditions, if any, under which the custody and care of the child may be returned to the parent(s) or guardian(s); (and it is further) F. Request for Return of Child [Required in all cases in which the petition is granted] “ ORDERED that the child shall be returned to the “ parent(s) “(guardian(s) in accordance with the terms and conditions of the placement instrument without further Court order; (and it is further) G. Native-American Children [Check box if applicable]: “ ORDERED that the following should be notified of this proceeding [specify]: the “ custodian of the child; “ tribe/nation; “ United States Secretary of the Interior “ ORDERED that in light of the assumption of jurisdiction by the tribe/nation, this petition is DISMISSED WITHOUT PREJUDICE; (and it is further) H. Date Certain for Permanency Hearing [Required in all cases where petition is granted] “ ORDERED that if the child(ren) remain(s) in foster care or in placement with a relative or other suitable person, the next permanency hearing shall be held on [specify date/time]: 3 Petitioner shall transmit notice of the hearing and a permanency report no later than 14 days in advance of the above date certain to the parents, other parties, attorneys, the attorney for the child and any pre-adoptive parent or relative providing care to the child(ren) and shall transmit notice of the hearing to former foster parent(s) who have had care of the child(ren) in excess of 12 months. “ A nd it is further O R D ER ED that ENTER ___________________________________ Dated: Judge of the Family Court 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: 9 Order mailed on [specify date(s) and to whom mailed]:____________________________ 9 Order received in court on [specify date(s) and to whom given]:_____________________ See Footnote 1. 3