Form Aap 6l - Adoption Assistance Program - Negotiated Benefit Amount And Approval Page 2
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8STATE OF CALIFORNIA – HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
Child’s Special Needs and Underlying Problem or Condition: ______________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
PART B
Date(s) of Contact with Family: __________________________________________________
Family’s AAP Benefit Request: $ _________ Maximum Eligible AAP Benefit: $ ________
Family and responsible public agency have agreed on the negotiated AAP benefit amount:
$ ________
Family and responsible public agency are unable to agree on an AAP benefit amount.
AAP 2 Completed with instructions to send Notice of Action stating requested
amount is denied.
AAP 6L (1/17)
PAGE 2 OF 8
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