Form Ad 4320l - Adoption Assistance Program (Aap) Agreement Page 6
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9STATE OF CALIFORNIA – HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
d. We are no longer legally responsible for the support of the child.
Failure to report these changes may result in an overpayment which may be
recovered by a direct charge or a reduction in current and future AAP benefits.
12. I/We understand that _______________________________ will remain eligible to
(Name Of Child)
receive an AAP benefit from the State of California regardless of the state in which
I/we reside. If a needed service is not available in my/our state of residence, the
________________________________ remains financially responsible for the
(Financial Responsible County Of Origin)
needed services.
13.
I
I/We understand that under the terms of this agreement the child is eligible for
Title IV-E (federal) AAP benefits and services under Title XIX (Medicaid) and
Title XX (Social Services) of the Federal Social Security Act.
___________________________ will help the child obtain these services by
providing information and referral services, if I/we live in or move to another
state.
AD 4320L (1/17)
PAGE 6 OF 9
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