Form Ad 4320l - Adoption Assistance Program (Aap) Agreement Page 2
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9STATE OF CALIFORNIA – HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
Complete Section I or II as appropriate.
SECTION I
1. An AAP benefit of $ ________________ per month and/or Medi-Cal is authorized to
(Amount)
begin ___________________. The child’s needs must be reassessed periodically, at
(Beginning Date Of Payment)
least every two years. The first scheduled reassessment is _____________________.
(First Reassessment Date)
2. Unless the benefit is ending because of age, ________________________________
(County Welfare Department)
will send me/us a Reassessment Information - Adoption Assistance Program (AAP 3)
form at least 60 days before the next reassessment date. I/We shall complete the AAP
3 and return it to the ___________________________________________________.
(Responsible Public Agency)
3. With my/our agreement, the responsible public adoption agency in accordance with
state law may increase or decrease the amount of the AAP benefit as my/our
circumstances or the needs of the child change.
4. For initial agreements signed prior to January 1, 2010, my child may be eligible for an
age-related increase after his or her 5th, 9th, 12th and 15th birthdays. In Marin
County, the age related increase occurs after his or her 5th, 7th, 9th, 12th, 13th and
15th birthdays. I/We shall contact the adoption agency to request this increase.
AD 4320L (1/17)
PAGE 2 OF 9
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