Form Ad 4320l - Adoption Assistance Program (Aap) Agreement Page 4
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9STATE OF CALIFORNIA – HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
If the child is under the age of three and the CRC has determined the child to have a
developmental disability as defined by the Lanterman Act, the maximum AAP benefit is
the current fiscal year (July 1st through June 30th) dual agency rate for a child three
years and older, there is no supplement to this rate.
8. If the child is a current consumer of CRC services, the maximum available AAP benefit
is the current fiscal year (July 1st through June 30th) dual agency rate for a child three
years and older (dual agency rate and eligible supplement to the rate not to exceed
$1,000). CRC consumers who have received a rate prior to July 2007, which exceeds
the maximum
eligible dual agency rate for the current fiscal year (July 1st through June 30th) for a child
three years and older plus supplement to the rate may continue to receive the higher rate
until the child is no longer eligible for AAP benefits or the adoption is dissolved.
9. I/We agree the AAP benefit of $ _________ will be directed to ___________________
(Amount)
(Name Of Facility)
for payment of out-of-home placement/Wraparound services for our child.
The AAP payment is authorized from _________________ to _______________.
(Beginning Date)
(End Date)
I/We understand the AAP payment is not to exceed the maximum state-approved
facility rate for which our child is eligible.
I/We agree in the month following the stated end date or if different, the date the child’s
out-of-home placement/Wraparound services ends, the AAP benefit will be changed to
the negotiated foster family home rate, applicable SCI rate or Dual Agency rate.
AD 4320L (1/17)
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