Form Dss-1839 - Nc Interstate Compact - Child Welfare Services Page 3
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4NC Interstate Compact
Order of Compliance
d. ( ) the child(ren) is/are currently in an emergency placement.
J. The department/agency has provided the court with a signed statement(s) from the
potential placement resource(s) or the assigned case manager in the sending state that
following a conversation with the potential placement resource, the potential placement
resource confirms/meets the minimum requirements as required under Paragraph 7a of
Regulation 7.
K. The sending agency has completed and is prepared to send all required paperwork to
the sending state ICPC office, including the statement from the prospective placement
resource or the assigned case manager under Paragraph 7a of Regulation 7, ICPC 100A
and ICPC Form 101.
IN CONSEQUENCE OF THE FOREGOING, IT IS, THEREFORE, ORDERED
AND ADJUDGED AS FOLLOWS:
1. This court, having jurisdiction over the above referenced child(ren), invokes the use of
the Interstate Compact on the Placement of Children and authorizes and directs this
state’s department/agency having custody of the child(ren) to be the sending agency in
this/these matter(s) and directs it to complete, execute, and file all necessary forms and
carry out and effectuate all obligations and responsibilities as the sending agency under
the Compact.
2. The department/agency shall seek the following:
a. ( ) Approval for a provisional placement of each child noted above in the
receiving state pending a more comprehensive home assessment of the potential
placement resource by the receiving state and an expedited placement decision
regarding final placement of the child(ren), or
b. ( ) A comprehensive home assessment of the potential placement resource in
the receiving state and an expedited placement decision without a provisional
placement of the subject child(ren), or
c. ( ) Approval for a provisional placement with a parent from whom the child
was not removed and concurrence to relinquish jurisdiction upon final approval.
3. The transmission of any documentation or request for information in this case/these
cases or decisions made shall be sent by overnight mail, FAX or as an attachment to an e-
mail if approved by receiving state or such other equally expedient method as may in the
future become available.
4. The court designates the clerk of court to send copies of this and other orders needed to
comply with Regulation 7 of the ICPC to the sending department/agency within two (2)
business days of the entry of this and other orders entered in this case:
a. name________________________________________
b. mailing address______________________________
c. e-mail address _______________________________
d. telephone number____________________________
e. FAX number _________________________________ -
DSS-1839 (Rev. 2/2012)
Child Welfare Services
ICPC Order of Compliance
Page 3 of 4
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