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JV-290 Caregiver Information Form

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CAREGIVER INFORMATION FORM

SUPERIOR COURT OF CALIFORNIA, COUNTY OF

STREET ADDRESS

MAILING ADDRESS

CITY AND ZIP CODE

BRANCH NAME

JV-290

FOR COURT USE ONLY

CASE NUMBER

To the foster parent or relative caregiver of the child: You may submit written information to the court or to the child's social worker, or you may attend review hearings. This optional form may assist you in providing written information to the court. Please type or print clearly in ink and submit the form well in advance of the hearing. Be aware that other individuals involved in the case have access to this information.

1. Child's name:

Child's date of birth:

Child's age:

2. Name of caregiver:

Address (confidential):

Phone no.:

Type of caregiver: Foster parent Relative Other (specify):

3. The child has been living in my home for

years months.

4. Current Status of Child's Medical/ Dental/ General Physical and Emotional Health

There is no new or additional information since the last court hearing.

There is new or additional information since the last court hearing (do not include the names of doctors):

5. Current Status of Child's Education

There is no new or additional information since the last court hearing.

There is new or additional information since the last court hearing (do not include the names of the schools):

6. a. The child is is not a special education student.

b. If the child is a special education student, please also state the date of the last Individual Education Plan (IEP):

7. Current Status of Child's Adjustment to Living Arrangement

There is no new or additional information since the last court hearing.

There is new or additional information since the last court hearing:

NAME OF CAREGIVER:

NAME OF CHILD:

CASE NUMBER

8. Current Status of Child's Social Skills /Peer Relationships

There is no new or additional information since the last court hearing.

There is new or additional information since the last court hearing:

9. Current Status of Child's Special Interests /Activities

There is no new or additional information since the last court hearing.

There is new or additional information since the last court hearing:

10. Other Helpful Information

There is no new or additional information since the last court hearing.

There is new or additional information since the last court hearing:

If you need more space to respond to any section above, please check this box and attach additional pages.

Number of pages attached (specify):

Date:

(TYPE OR PRINT NAME)

(SIGNATURE OF CAREGIVER)

Form Approved for Optional Use

JV-290 [New January 1, 2002]

CAREGIVER INFORMATION FORM

Page 1 of 2

electronic form ©2001

WWW.LawCA.com

Law Publishers

Welfare and Institutions Code §

366.21~b)

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What the JV-290 Caregiver Information Form Is and when it's used

The JV-290 Caregiver Information Form is a judicial-court form used to record identifying, contact, and caregiving details for an adult who provides care to a child in a juvenile dependency or related proceeding. It collects caregiver name, relationship to the child, address, phone and email, duration and scope of care, and any statements about legal authority or temporary custody. Courts and child welfare agencies use the form to support placement decisions, service planning, and to create a clear administrative record for hearings and case files.

Why completing JV-290 carefully matters

A fully completed JV-290 supports accurate court records, helps case workers reach caregivers quickly, and reduces delays at hearings or placement reviews. Accurate caregiver details protect the child by clarifying who has day-to-day responsibility and any legal authority granted.

Why completing JV-290 carefully matters

Who typically completes or receives the JV-290

The JV-290 is completed and used by multiple parties working on juvenile dependency and placement matters.

  • County social workers and case managers who collect caregiver data during assessment and placement activities.
  • Caregivers and relatives who provide their own identifying information and availability for care or visitation.
  • Attorneys, guardians ad litem, and court staff who rely on the form to confirm caregiver contact and authority.

Step-by-step: filling out JV-290 accurately

Follow these steps in order to prepare a complete, court-ready form.

  • 01
    Gather documents: Collect ID, proof of address, and emergency contacts before you start.
  • 02
    Complete fields: Enter caregiver name, relationship, address, contacts, and availability.
  • 03
    Review and initial: Verify all entries for accuracy and add initials where required.
  • 04
    Sign and submit: Obtain signature and date; route to case worker or court clerk.

Typical workflow for collecting and routing the JV-290

A standard process reduces missing information and speeds case handling.

  • Upload form: Sender uploads JV-290 to case file or form platform.
  • Add fields: Place signature/date and contact fields for caregiver completion.
  • Assign signers: Add caregiver and case worker as signers or reviewers.
  • Send and track: Transmit the form, monitor completion, and save the audit trail.

Recommended digital settings for JV-290 e-submission

Configure these workflow settings when using an eSignature or case-management platform to collect JV-290 data securely.

Field Configuration
Authentication Email verification or SMS code for signer identity
Signature Type Standard electronic signature with timestamp
Notifications Automatic reminders to caregivers and case workers
Storage Encrypted archival with access controls

Technical considerations for eSubmission and storage

Ensure the platform you use supports secure file formats and appropriate signer authentication before collecting JV-290 electronically.

  • File Types: PDF and DOCX are commonly accepted and preserve layout
  • Integrations: Connectors to case management or cloud storage are useful
  • Authentication: Email/SMS or stronger methods reduce identity risk

Essential parts of a professional JV-290 submission

A complete JV-290 groups administrative identifiers, caregiver facts, legal authority statements, and a traceable signature block for adjudication and recordkeeping.

Case Number

Record the court case number consistently to link the caregiver form with the juvenile dependency file and avoid misfiling.

Child Identifiers

Include child name, date of birth, and placement status so the form can be matched in databases and hearing packets.

Caregiver Details

Provide caregiver legal name, full address, contact numbers, and relationship to the child to support visits and background checks.

Authority Statement

State whether caregiver has temporary custody, permission to consent to medical care, or other delegated authority with clear dates.

Supporting Documents

Attach ID copies, proof of residence, and any court orders that clarify caregiver status to reduce follow-up requests.

Signature Block

Include dated caregiver signature, printed name, and case worker acknowledgement to create a complete, auditable record.

Data and privacy safeguards to apply to JV-290 records

Personal Data: Limit collection to required items only
Encryption: Encrypt at rest (AES-256) and in transit (TLS 1.2/1.3)
Access Controls: Role-based access to case files
HIPAA Consideration: Treat health details as PHI when present
Audit Trail: Record timestamps, IP, and actions
BAA Requirement: Use a BAA for platforms handling PHI

Risks and legal consequences of incorrect JV-290 entries

Missing Signature: May delay placement or court acceptance
Incorrect Contact: Hinders emergency notification and services
Privacy Breach: Could trigger HIPAA/agency reporting obligations
False Statements: May expose signer to perjury charges
Incomplete Authority: Limits caregiver's ability to consent to care
Late Filing: Can postpone hearings or placements

Common preparation mistakes to avoid

  • Using informal or nicknames instead of the caregiver's legal name causes mismatches with background checks and identity verification.
  • Failing to provide a full street address or relying on a P.O. box prevents physical-home assessments required by many counties.
  • Entering tentative or approximate dates rather than exact MM/DD/YYYY values creates confusion around start of care and court scheduling.
  • Not attaching required supporting documents such as ID, proof of residence, or court orders results in repeated follow-up and processing delays.

Representative eSignature provider comparison for JV-290 workflows

Compare starting price, trial availability, bulk-send capabilities, audit trails, HIPAA support, and envelope or session caps when selecting an eSignature vendor.

signNow DocuSign Adobe Sign PandaDoc HelloSign
Starting Price $8/user/mo $15/user/mo $14/user/mo $19/user/mo $15/user/mo
Free Trial 7-day free trial Varies by plan Varies by plan Varies by plan Varies by plan
Bulk Send Yes Yes Yes Yes Varies
Audit Trail Yes Yes Yes Yes Yes
HIPAA Compliant Yes Yes Yes No No

Frequently asked questions about completing the JV-290

Answers to common practical questions about form completion, digital signing, submission, and recordkeeping.


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