Form Rfa 812 - Detail Supportive Information
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1STATE OF CALIFORNIA
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
HEALTH AND HUMAN SERVICES AGENCY
RESOURCE FAMILY APPROVAL
DETAIL SUPPORTIVE INFORMATION
Type of Activity:
This form is intended to document information that is relevant to the Resource Family file but generally not public information, such as
collateral visits. This would include back-up information on deficiencies such as conditions contributing to the severity of the allegations,
witnesses to the allegations, or other observation from field notes. When used to support the Resource Family Visit Record (RFA 809)
the form should be completed, signed and dated shortly after the visit. This ensures accuracy and completeness of the detail of the
public record.
Public
Confidential
o
o
DATE(S) OF CONTACT:
RF NAME:
RF ID NUMBER:
COLLATERAL VISIT:
YES
NO
RF WORKER SIGNATURE:
RF WORKER NAME (PRINT):
DATE:
RFA 812 (6/17) (PERSONAL/CONFIDENTIAL DEPENDING ON TYPE OF INFORMATION) (OPTIONAL)
PAGE____ OF____ PAGES
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Parent category: Legal