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13. The home study preparer must ask each PAP and any additional adult household member, whether or not he or she

previously has had a prior home study completed or began a home study process related to an adoption or any form

of foster or other custodial care of a child that was not completed, whether or not the prior home study related to an

intercountry adoption. Each individual’s response to this question must be included in the home study report.

If the applicant or any additional adult member of the household did have a previous home study completed, and

the results were unfavorable, a copy of the unfavorable home study should be submitted, if available, as supporting

documentation to USCIS as part of filing Form I-800A. See sample on the following page.

Sample Wording:

“In response to a direct question from this worker, Bradley indicates that he had never previously had a home study

completed or began a home study process related to an adoption or for any form of foster or custodial care of a child

that was not completed.

In response to a direct question from this worker, Susan indicated that she has previously had a home study completed

for the purpose of international adoption. Susan previously adopted one child from Country X in June 2002 with a

former spouse. The prior home study was initiated by Baby Town Adoption Agency on December 3, 2001, and was

completed on March 17, 2002.

In response to direct questions asked by this worker, both Bradley and Susan responded “no” to the following

questions:

A. Have you ever been denied as a PAP or been the subject of an unfavorable home study?

B. Have you ever begun a home study process in relation to an adoption or to any form of foster or other custodial

care of a child that was not completed?”

14. The home study preparer must specifically state the reasons for the decision. If approving the PAP to adopt, the

home study preparer must include his or her specific approval of the PAP for adoption of a child from the specific

Convention country or countries and a discussion of the reasons for such approval. The discussion must address:

1) the number of children for which they are recommended to adopt at the same time, 2) whether there are any specific

restrictions to the adoption based on age or gender or other characteristics of the child, and 3)if they are approved to

parent a child with a disability or special needs. See sample below:

Sample Wording:

“Mr. and Mrs. Smith are approved to adopt one female child, age 0-4 years from Country Z. The family is approved

for a child with minor to moderate special needs, including but not limited to cleft lip and palate, thalassemia, partial

hearing loss, webbed fingers or toes, congenital heart defect, ASD, or a child who is a Hepatitis B carrier. It is my

pleasure to recommend that Country Z place such a child with the Smith family of State X, USA.”

15. The home study must include a summary of the home study preparer’s authority to conduct home studies. This should

include the license number, if any, or authorization of the home study preparer as an adoption service provider. See

sample below:

Sample Wording #1 - Exempted Provider:

“Prepared by Anne Marie Davis, LCSW, license 17895, expires 12/31/2010, who is authorized by the State of X to

research and prepare home studies.

In accordance with 22 CFR Part 96, American Adoption Services, Inc. (State X license # 99451, expires November

10, 2009) is an accredited agency on file with the U.S. Department of State as having the authority to conduct Hague

Convention Country home studies and has reviewed and approved the home study for Mr. and Mrs. Smith and met the

conditions set forth in 22 CFR 96.47(c).”

Form M-738 Instructions 07/27/09 N

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Instructions For Form M-738 - Hague Home Study Tip Sheet For Adoption Service Providers And Prospective Adoptive Parents Page 6