INTER-COUNTY AGREEMENT
ON THE PLACEMENT OF CHILDREN
THIS AGREEMENT made this
day of
, 20
, by and between the
County Department of Social Services hereinafter called the RESIDENT
COUNTY, and
County Department of Social Services hereinafter called the
SUPERVISING COUNTY, concerning the safety resource, kinship/foster care placement of:
Name of Child:
Status of the child (custody with DSS?)
The agreement will be effective on the
day of
, 20
, and ending on the
day of
, 20
.
PLACEMENT
The child(ren) are place with _________________________________________________(
), who reside at
Name
_________________________________________________________________________. The placement
provider is _________________________________________________________________(
,
Relationship
licensed
).
foster parent, kinship, safety resource, other
This placement is sanctioned by _______________________________________________________(
).
Court, DSS
The Initial Kinship Care Assessment was completed on ________________________________________(
)
Date
.
The Comprehensive Kinship Care Assessment is due/has been completed on_______________________(
).
Date
PAYMENT
If Applicable
That in consideration of the representations made by the Supervising County and the Resident County, the
Resident County will pay to the Supervising County the amount of $
per month for board,
for children in the custody of the Resident County. The first payment will be made
day of
, 20
, and subsequent board payments will be made no later than the
____ of each
month. Children that are placed with a safety resource do not qualify for board payments.
ACTIVITIES
The Supervising County will accept full responsibility for the supervision of child upon receipt of agreement
from the Resident County.
Activities will include: (
)
if applicable
____ Completion of the Comprehensive Kinship Care Assessment.
____ Monitoring the placement through visits conducted _______(
)
Weekly, monthly, other
____ Provide documentation of visits to the child and the placement resource that is current
within 7 business days.
DSS-1797 (Rev. 09/07)
FSCWS