Adoption Assistance Agreement - Minnesota Department Of Human Services
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8Revised 11/06/08
MINNESOTA DEPARTMENT OF HUMAN SERVICES
ADOPTION ASSISTANCE AGREEMENT
T
he commissioner of the Minnesota Department of Human Services is authorized to enter into Adoption Assistance
Agreements pursuant to Minnesota Statutes, section 259.67.
Frank Clark
County Human Services, (hereinafter “placing agency”), has certified
(hereinafter the “child”), who was
born on 11/25/2006 as eligible for
Title IV-E
state-funded Adoption Assistance. The following agreement has been
entered into by and between the commissioner of the Minnesota Department of Human Services (hereinafter
“commissioner”), Steve Clark (hereinafter “adoptive parent(s)”), and the placing agency for the purpose of facilitating the
legal adoption of the child and to aid the adoptive family in providing proper care for the child.
This document is the initial Adoption Assistance Agreement. The adoptive parent(s) agree that they intend to adopt
the child named above and that they have signed this document prior to finalization of the adoption. The agreement is
subject to the court granting the adoption petition and begins on the date that the adoption decree is issued.
This document is the initial Adoption Assistance Agreement. The finalization of the adoption for the child named
above has already occurred; eligibility for Adoption Assistance has been ordered through a fair hearing. A copy of the
order issued by the Appeals and Regulations Division is attached to this agreement. The agreement is effective from
the date indicated in the order.
PROVISIONS OF AGREEMENT
I.
Assistance
A.
Monthly Adoption Assistance
1.
Total Monthly Payment
The monthly payment shall total $277 per month.
This child’s eligibility for Adoption Assistance is based solely on the child being at high
risk of developing physical, mental, emotional, or behavioral disabilities. When a child’s
eligibility for Adoption Assistance is based upon the high risk of developing physical,
mental, emotional, or behavioral disabilities, no payment will be made unless and until
the potential disability manifests itself as documented by an appropriate professional,
and the commissioner authorizes commencement of a payment by modifying this
agreement accordingly.
The placing agency must identify resources available to meet the child’s special needs before the
amount of the monthly payment is determined. The amount of the monthly adoption assistance
payment shall not exceed the monthly foster care maintenance payment and difficulty of care
payment for the child if he/she was in a foster home in Minnesota. Adjustments in the monthly
adoption assistance amount may be made with the concurrence of the adoptive parent(s) and the
commissioner.
For state-funded Adoption Assistance Agreements only: the amount of the monthly adoption
assistance payment is subject to the availability of state funds.
2.
Basic Maintenance Payment
A monthly basic maintenance needs payment is available to assist in meeting the basic needs of
the child, such as food, clothing and shelter. Monthly basic maintenance payments for adoption
assistance are made according to the following schedule:
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