Form Aap 8 - Adoption Assistance Program - Nonrecurring Adoption Expenses Agreement
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1State of California – Health and Human Services Agency
California Department of Social Services
ADOPTION ASSISTANCE PROGRAM
NONRECURRING ADOPTION EXPENSES AGREEMENT
Adoptive parents may be reimbursed for nonrecurring adoption expenses of up to $400 per adoption
of a special needs child pursuant to Welfare and Institutions Code (W&IC) Section 16120.1. The term
“nonrecurring adoption expenses” is defined as the reasonable and necessary adoption fees, court
costs, attorney fees and other expenses which are directly related to the legal adoption of a child with
special needs, which are not incurred in violation of State or Federal law, and which have not been
reimbursed from other sources or funds.
Other allowable costs of the adoption incurred by or on behalf of the parents and for which parents
carry the burden for payment, may include: the adoption homestudy, health and psychological
examinations, supervision of the placement prior to the adoption, transportation and reasonable
costs of lodging and food for the child and/or the adoptive parents when necessary to complete the
adoption process.
To be eligible for nonrecurring adoption expenses the child must meet the three part special needs
determination and be a United States citizen or qualified alien as stated in W&IC Section 16120 (a)
through (c) and (l).
Financially Responsible County:
Adoptive Placement Date:
_______________________________
________________
Name
Child’s Name:
______________________________________________________________________________________________________
I/We,
and
, have
_____________________________________________
___________________________________________________
Name of Parent
Name of Parent
entered into an agreement with the
for the Nonrecurring
________________________________________________
Responsible Public Agency
Adoption Expense Reimbursement Amount of $
_________________
for
______________________________________________________________________
Name of Child
Claim for payment including receipts and all related nonrecurring adoption expenses documentation
is attached.
Or
I/We,
and
, have
_______________________________________________
_______________________________________________
Name of Parent
Name of Parent
been notified that we may be eligible to receive these funds and the claim for payment including
receipts and all related nonrecurring adoption expenses documentation will be submitted to
no later than two years from date of finalization.
______________________________________________________________
Responsible Public Agency
Adoptive Parent
Date
Adoptive Parent
Date
Responsible Public Agency Representative
Date
Responsible Public Agency Name
AAP 8 (12/17)
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