Provider Forms & Documents

English: <a href="https://files.dcs.tn.gov/forms/0629I.doc" target="blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0629SI.doc" target="blank">Click to Open</a> English: <a href="https://files.dcs.tn.gov/forms/0669.doc" target="blank">Click to Open</a><br />Spanish: n/a Civil Rights English: <a href="https://files.dcs.tn.gov/forms/0994.pdf" target="_blank">Click to Open</a><br />Spanish: n/a English: <a href="https://files.dcs.tn.gov/forms/0983.doc" target="blank">Click to Open</a><br />Spanish: n/a English: <a href="https://files.dcs.tn.gov/forms/0921.doc" target="blank">Click to Open</a><br />Spanish: n/a Staffing Plan Assessment Program Agreement - BSW-BSSW Tuition Assistance Program CS-0982 Daily Rate Child Placement Contract Between DCS, TN Baptist Children's Homes and Foster Parents CS-0998 English: <a href="https://files.dcs.tn.gov/forms/0984.pdf" target="_blank">Click to Open</a><br />Spanish: n/a English: <a href="https://files.dcs.tn.gov/forms/0813I.doc" target="blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0813SI.doc" target="blank">Click to Open</a> English: <a href="https://files.dcs.tn.gov/forms/0559I.doc" target="blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0559SI.doc" target="blank">Click to Open</a> English: <a href="https://files.dcs.tn.gov/forms/0813.pdf" target="_blank">Click to Open</a><br />Spanish: n/a English: <a href="https://files.dcs.tn.gov/forms/0614.doc" target="blank">Click to Open</a><br />Spanish: n/a Foster Care English: <a href="https://files.dcs.tn.gov/forms/0702I.doc" target="blank">Click to Open</a><br />Spanish: n/a Waiver of Criminal Convictions, Pre and In-Service Training Requirements, Non-Safety Issues, CPS Substantiations and Education Requirement CS-0921 English: <a href="https://files.dcs.tn.gov/forms/0422I.doc" target="blank">Click to Open</a><br />Spanish: n/a English: <a href="https://files.dcs.tn.gov/forms/1157.doc" target="blank">Click to Open</a><br />Spanish: n/a English: <a href="https://files.dcs.tn.gov/forms/0017.pdf" target="_blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0017S.pdf" target="_blank">Click to Open</a> Independent Living English: <a href="https://files.dcs.tn.gov/forms/0206.pdf" target="_blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0206S.pdf" target="_blank">Click to Open</a> English: <a href="https://files.dcs.tn.gov/forms/0969.doc" target="blank">Click to Open</a><br />Spanish: n/a Health Services Confirmation and Follow-Up Notification CS-0689 English: <a href="https://files.dcs.tn.gov/forms/1017.pdf" target="_blank">Click to Open</a><br />Spanish: n/a English: <a href="https://files.dcs.tn.gov/forms/0439.doc" target="blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0439S.doc" target="blank">Click to Open</a> Clinical Service Provider Qualifications CS-1231 Request for Foster Home Transfer CS-0985 Tier II Request for Appeal CS-1062 Foster Parent Applicant Questionnaire CS-0962 0727-1 0496 English: <a href="https://files.dcs.tn.gov/forms/0496.doc" target="blank">Click to Open</a><br />Spanish: n/a English: <a href="https://files.dcs.tn.gov/forms/0727I.doc" target="blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0727SI.doc" target="blank">Click to Open</a> English: <a href="https://files.dcs.tn.gov/forms/0559.doc" target="blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0559S.doc" target="blank">Click to Open</a> Foster Home Approval CS-0702 English: <a href="https://files.dcs.tn.gov/forms/0676.doc" target="blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0676S.doc" target="blank">Click to Open</a> Drug Screen Consent/Refusal and Results CS-0831 English: <a href="https://files.dcs.tn.gov/forms/0976.pdf" target="_blank">Click to Open</a><br />Spanish: n/a English: <a href="https://files.dcs.tn.gov/forms/1230.doc" target="blank">Click to Open</a><br />Spanish: n/a English: <a href="https://files.dcs.tn.gov/forms/0583.doc" target="blank">Click to Open</a><br />Spanish: n/a English: <a href="https://files.dcs.tn.gov/forms/0962.doc" target="blank">Click to Open</a><br />Spanish: n/a Authorization for Routine Health Services for Minors CS-0206 Special Needs Justification CS-0934 English: <a href="https://files.dcs.tn.gov/forms/0692.doc" target="blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0692S.doc" target="blank">Click to Open</a> English: <a href="https://files.dcs.tn.gov/forms/1217.doc" target="blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/1217S.doc" target="blank">Click to Open</a> English: <a href="https://files.dcs.tn.gov/forms/0460I.doc" target="blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0460SI.doc" target="blank">Click to Open</a> English: <a href="https://files.dcs.tn.gov/forms/0435I.doc" target="blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0435SI.doc" target="blank">Click to Open</a> Record of Training Participation CS-0752 English: <a href="https://files.dcs.tn.gov/forms/0636I.doc" target="blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0636SI.doc" target="blank">Click to Open</a> English: <a href="https://files.dcs.tn.gov/forms/1033.doc" target="blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/1033S.doc" target="blank">Click to Open</a> English: <a href="https://files.dcs.tn.gov/forms/0620.doc" target="blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0620S.doc" target="blank">Click to Open</a> Foster Care & JJ 0158 Psychotropic Medication Evaluation CS-0629 Post-Adoptions English: <a href="https://files.dcs.tn.gov/forms/1158.pdf" target="_blank">Click to Open</a><br />Spanish: n/a English: <a href="https://files.dcs.tn.gov/forms/0970.doc" target="blank">Click to Open</a><br />Spanish: n/a PAR Sub-Contract Request with Non-Performance-Based (PBC) Entities CS-0971 English: <a href="https://files.dcs.tn.gov/forms/0778I.doc" target="blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0778SI.doc" target="blank">Click to Open</a> English: <a href="https://files.dcs.tn.gov/forms/1203.doc" target="blank">Click to Open</a><br />Spanish: n/a Curriculum Development Request Application for Adoption Assistance CS-0930 Application - DCS Tuition Assistance Program BSW-BSSW Program CS-0975 English: <a href="https://files.dcs.tn.gov/forms/0977.doc" target="blank">Click to Open</a><br />Spanish: n/a Current Description of Child CS-1033 English: <a href="https://files.dcs.tn.gov/forms/0831.pdf" target="_blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0831S.pdf" target="_blank">Click to Open</a> English: <a href="https://files.dcs.tn.gov/forms/0629.doc" target="blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0629S.doc" target="blank">Click to Open</a> English: <a href="https://files.dcs.tn.gov/forms/0674I.doc" target="blank">Click to Open</a><br />Spanish: n/a English: <a href="https://files.dcs.tn.gov/forms/1044.doc" target="blank">Click to Open</a><br />Spanish: n/a English: <a href="https://files.dcs.tn.gov/forms/0780.pdf" target="_blank">Click to Open</a><br />Spanish: n/a English: <a href="https://files.dcs.tn.gov/forms/0984.doc" target="blank">Click to Open</a><br />Spanish: n/a English: <a href="https://files.dcs.tn.gov/forms/1229.doc" target="blank">Click to Open</a><br />Spanish: n/a English: <a href="https://files.dcs.tn.gov/forms/0934.doc" target="blank">Click to Open</a><br />Spanish: n/a English: <a href="https://files.dcs.tn.gov/forms/0749.doc" target="blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0749S.doc" target="blank">Click to Open</a> Centralized Perm. Services English: <a href="https://files.dcs.tn.gov/forms/0636.pdf" target="_blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0636S.pdf" target="_blank">Click to Open</a> Fiscal English: <a href="https://files.dcs.tn.gov/forms/0998.doc" target="blank">Click to Open</a><br />Spanish: n/a Individual Conflict of Interest Statement CS-0972 Border Agreement Kinship Home Placement Checklist and Consent for Medical Treatment CS-0927 Child Safety Plan CS-1044 English: <a href="https://files.dcs.tn.gov/forms/1158.doc" target="blank">Click to Open</a><br />Spanish: n/a Individual Sub-Contract CS-0970 Incident Report - DCS Tuition Assistance Program CS-0980 English: <a href="https://files.dcs.tn.gov/forms/0761I.doc" target="blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0761SI.doc" target="blank">Click to Open</a> English: <a href="https://files.dcs.tn.gov/forms/1000I.doc" target="blank">Click to Open</a><br />Spanish: n/a Fingerprint Card Information CS-0691 Foster Parent Individual TN KEYS Training Plan CS-1158 English: <a href="https://stateoftennessee.formstack.com/forms/request_for_curriculum_development" target="_blank">Click to Open</a><br />Spanish: n/a English: <a href="https://files.dcs.tn.gov/forms/1097.doc" target="blank">Click to Open</a><br />Spanish: n/a Monthly Family Income and Expenditures CS-0431 English: <a href="https://files.dcs.tn.gov/forms/0871I.doc" target="blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0871SI.doc" target="blank">Click to Open</a> English: <a href="https://files.dcs.tn.gov/forms/0890.doc" target="blank">Click to Open</a><br />Spanish: n/a Independent Living Program Review Request CS-0761 English: <a href="https://files.dcs.tn.gov/forms/0972I.doc" target="blank">Click to Open</a><br />Spanish: n/a English: <a href="https://files.dcs.tn.gov/forms/POPSTool.doc" target="blank">Click to Open</a><br />Spanish: n/a Border Agreement Non-Custodial Immediate Safety Plan CS-0928 English: <a href="https://files.dcs.tn.gov/forms/0678I.doc" target="blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0678SI.doc" target="blank">Click to Open</a> English: <a href="https://files.dcs.tn.gov/forms/0705-1.pdf" target="_blank">Click to Open</a><br />Spanish: n/a English: <a href="https://files.dcs.tn.gov/forms/0636.doc" target="blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0636S.doc" target="blank">Click to Open</a> Supplier Direct Deposit Authorization (ACH) 0083 English: <a href="https://files.dcs.tn.gov/forms/0427.doc" target="blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0427S.doc" target="blank">Click to Open</a> English: <a href="https://files.dcs.tn.gov/forms/0628.pdf" target="_blank">Click to Open</a><br />Spanish: n/a English: <a href="https://files.dcs.tn.gov/forms/0627.doc" target="blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0627S.doc" target="blank">Click to Open</a> Foster Parent Elective Training Documentation CS-1000 English: <a href="https://files.dcs.tn.gov/forms/0836.doc" target="blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0836S.doc" target="blank">Click to Open</a> English: <a href="https://files.dcs.tn.gov/forms/0670.doc" target="blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0670S.doc" target="blank">Click to Open</a> Title VI/Title IX Complaint CS-0636 Recovery Checklist for Absconders/Runaways/Escapees CS-0705-1 English: <a href="https://files.dcs.tn.gov/forms/0927.doc" target="blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0927S.doc" target="blank">Click to Open</a> English: <a href="https://files.dcs.tn.gov/forms/0961.doc" target="blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0961S.doc" target="blank">Click to Open</a> English: <a href="https://files.dcs.tn.gov/forms/0909.doc" target="blank">Click to Open</a><br />Spanish: n/a Relative Caregiver Program Brochure Foster Family Reference Letter and Questionnaire CS-0963 English: <a href="https://files.dcs.tn.gov/forms/0773.pdf" target="_blank">Click to Open</a><br />Spanish: n/a HR 0093 Plan of Study - DCS Tuition Assistance BSW/BSSW Program CS-0981 English: <a href="https://files.dcs.tn.gov/forms/0971.doc" target="blank">Click to Open</a><br />Spanish: n/a Waiver Request for Placement with Contract Agency Employee CS-1079 English: <a href="https://files.dcs.tn.gov/forms/1059.doc" target="blank">Click to Open</a><br />Spanish: n/a English: <a href="https://files.dcs.tn.gov/forms/0934I.doc ">Click to Open</a><br />Spanish: n/a English: <a href="https://files.dcs.tn.gov/forms/1000.doc" target="blank">Click to Open</a><br />Spanish: n/a Foster Parent/Other Adult Medical Report CS-0678 Medication for Pass CS-0836 English: <a href="https://files.dcs.tn.gov/intranet/forms/0093.pdf" target="_blank">Click to Open</a><br />Spanish: n/a English: <a href="https://files.dcs.tn.gov/forms/0689I.doc" target="blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0689SI.doc" target="blank">Click to Open</a> Foster Family Home Study Recommendations and Signature Page Student Reference Recommendation - DCS BSW/BSSW Tuition Assistance Program CS-0984 Incident Report CS-0496 English: <a href="https://files.dcs.tn.gov/intranet/forms/0935I.doc" target="blank">Click to Open</a><br />Spanish: n/a Application for Child Welfare Case Management Certification CS-0994 JJ Adoption Record Face Sheet (Closed) CS-0677 Notice of Intent to Claim Paternity or Acknowledgement of Paternity of a Child CS-0439 Relative Caregiver Program Action Plan CS-0620 English: <a href="https://files.dcs.tn.gov/forms/0688.doc" target="blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0688S.doc" target="blank">Click to Open</a> EPSDT Screening Report CS-1096 English: <a href="https://files.dcs.tn.gov/forms/0813.doc" target="blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0813S.doc" target="blank">Click to Open</a> Acknowledgement of Understanding Regarding Placement Acceptance CS-1217 English: <a href="https://files.dcs.tn.gov/forms/0618I.doc" target="blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0618SI.doc" target="blank">Click to Open</a> English: <a href="https://files.dcs.tn.gov/forms/0831I.doc" target="blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0831SI.doc" target="blank">Click to Open</a> Foster Parent Waiver of Right to Appeal the Removal of a Child and Right to 14 Day Notice CS-0583 English: <a href="https://files.dcs.tn.gov/forms/0930.doc" target="blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0930S.doc" target="blank">Click to Open</a> English: <a href="https://files.dcs.tn.gov/forms/0980.pdf" target="_blank">Click to Open</a><br />Spanish: n/a Case Record Review Notice English: <a href="https://files.dcs.tn.gov/forms/1093.doc" target="blank">Click to Open</a><br />Spanish: n/a Profile of Parenting Study Tool English: <a href="https://files.dcs.tn.gov/forms/1227.pdf" target="_blank">Click to Open</a><br />Spanish: n/a English: <a href="https://files.dcs.tn.gov/forms/0960.doc" target="blank">Click to Open</a><br />Spanish: n/a English: <a href="https://files.dcs.tn.gov/intranet/forms/SupDirDepAuth.pdf" target="_blank">Click to Open</a><br />Spanish: n/a Performance Based Contracting Formal Committee Review CS-0960 English: <a href="https://files.dcs.tn.gov/forms/1229.pdf" target="_blank">Click to Open</a><br />Spanish: n/a English: <a href="https://files.dcs.tn.gov/forms/0921I.doc" target="blank">Click to Open</a><br />Spanish: n/a English: <a href="https://stateoftennessee.formstack.com/forms/dcs_staff_supplemental">Click to Open</a><br />Spanish: n/a Discipline Policy CS-0553 English: <a href="https://files.dcs.tn.gov/forms/0890I.doc" target="blank">Click to Open</a><br />Spanish: n/a English: <a href="https://files.dcs.tn.gov/forms/0687.pdf" target="_blank">Click to Open</a><br />Spanish: n/a English: <a href="https://files.dcs.tn.gov/forms/0450I.doc" target="blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0450SI.doc" target="blank">Click to Open</a> English: <a href="https://files.dcs.tn.gov/forms/1019.pdf" target="_blank">Click to Open</a><br />Spanish: n/a English: <a href="https://files.dcs.tn.gov/forms/0928I.doc" target="blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0928SI.doc" target="blank">Click to Open</a> English: <a href="https://files.dcs.tn.gov/forms/0670I.doc" target="blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0670SI.doc" target="blank">Click to Open</a> English: <a href="https://files.dcs.tn.gov/forms/0727.pdf" target="_blank">Click to Open</a><br />Spanish: n/a English: <a href="https://files.dcs.tn.gov/forms/0817.doc" target="blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0817S.doc" target="blank">Click to Open</a> English: n/a<br />Spanish: n/a Verification of Financial Responsibility for Adoption Assistance CS-0017 Child's Medical Record CS-0427 Request for Name and/or Address of Father with Claim of Paternity CS-0435 Records English: <a href="https://files.dcs.tn.gov/forms/0773I.doc" target="blank">Click to Open</a><br />Spanish: n/a English: <a href="https://files.dcs.tn.gov/forms/0158.pdf" target="_blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0158S.pdf" target="_blank">Click to Open</a> English: <a href="https://files.dcs.tn.gov/forms/0981.pdf" target="_blank">Click to Open</a><br />Spanish: n/a Request for Payment for Non-Recurring/Legal Expenses for DCS Custodial Children Ineligible for Adoption Subsidy CS-1203 English: <a href="https://files.dcs.tn.gov/forms/1053.doc" target="blank">Click to Open</a><br />Spanish: n/a English: <a href="https://files.dcs.tn.gov/forms/0910.doc" target="blank">Click to Open</a><br />Spanish: n/a English: <a href="https://files.dcs.tn.gov/forms/0959I.doc" target="blank">Click to Open</a><br />Spanish: n/a English: <a href="https://files.dcs.tn.gov/forms/0982.pdf" target="_blank">Click to Open</a><br />Spanish: n/a Foster Family Home Study CS-0961 English: <a href="https://files.dcs.tn.gov/forms/1096.doc" target="blank">Click to Open</a><br />Spanish: n/a English: <a href="https://files.dcs.tn.gov/forms/1228.doc" target="blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/1228S.doc" target="blank">Click to Open</a> English: <a href="https://files.dcs.tn.gov/forms/0979.doc" target="blank">Click to Open</a><br />Spanish: n/a OIT Confidentiality Agreement CS-0684 English: <a href="https://files.dcs.tn.gov/intranet/forms/0093I.doc" target="blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0093SI.doc" target="blank">Click to Open</a> English: <a href="https://files.dcs.tn.gov/forms/0431.doc" target="blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0431S.doc" target="blank">Click to Open</a> Confidentiality Agreement for Full Disclosure CS-1039 Relative Caregiver Program Determination of Financial Eligibility CS-0614 Performance Based Contracting Formal Review Request CS-0959 English: <a href="https://files.dcs.tn.gov/forms/0983.pdf" target="_blank">Click to Open</a><br />Spanish: n/a 0909 Authorization to Release Academic Information - DCS Tuition Assistance Programs CS-0978 Foster Parent Training Sign-in Sheet CS-1157 Contractor List of Owners and Board Members CS-0973 English: <a href="https://files.dcs.tn.gov/forms/1079.doc" target="blank">Click to Open</a><br />Spanish: n/a English: <a href="https://files.dcs.tn.gov/forms/CaseRecRevNot.doc" target="blank">Click to Open</a><br />Spanish: n/a Power of Attorney for Care of a Minor Child CS-0817 Approval of Participation - DCS MSW/MSSW Tuition Assistance Program CS-0977 Child Safety English: <a href="https://files.dcs.tn.gov/forms/0871.doc" target="blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0871S.doc" target="blank">Click to Open</a> English: <a href="https://files.dcs.tn.gov/forms/1016.doc" target="blank">Click to Open</a><br />Spanish: n/a English: <a href="https://files.dcs.tn.gov/forms/0928.doc" target="blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0928S.doc" target="blank">Click to Open</a> Adoption Assistance Agreement CS-0513 72 Hour Health Screening Report CS-1097 English: <a href="https://files.dcs.tn.gov/forms/0976.doc" target="blank">Click to Open</a><br />Spanish: n/a English: <a href="https://files.dcs.tn.gov/forms/0435.doc" target="blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0435S.doc" target="blank">Click to Open</a> Visitation Observation Checklist CS-0594 0705-1 English: <a href="https://files.dcs.tn.gov/forms/0017.doc" target="blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0017S.doc" target="blank">Click to Open</a> 0910 Intent to Adopt Placement Agreement CS-0460 English: <a href="https://files.dcs.tn.gov/forms/0741.doc" target="blank">Click to Open</a><br />Spanish: n/a Internal Affairs 0929 0961-1 English: <a href="https://files.dcs.tn.gov/forms/0431.pdf" target="blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0431S.pdf" target="blank">Click to Open</a> English: <a href="https://files.dcs.tn.gov/forms/0929I.doc" target="blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0929SI.doc" target="blank">Click to Open</a> Foster Home Disaster Plan CS-0871 0927 0928 Foster Parent Oath to Abide CS-0670 English: <a href="https://files.dcs.tn.gov/forms/0959.doc" target="blank">Click to Open</a><br />Spanish: n/a English: <a href="https://files.dcs.tn.gov/forms/0961I.doc" target="blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0961SI.doc" target="blank">Click to Open</a> 0921 English: <a href="https://files.dcs.tn.gov/forms/0319I.doc" target="blank">Click to Open</a><br />Spanish: n/a English: <a href="https://files.dcs.tn.gov/forms/1016.pdf" target="_blank">Click to Open</a><br />Spanish: n/a English: <a href="https://files.dcs.tn.gov/forms/1019.doc" target="blank">Click to Open</a><br />Spanish: n/a Foster Home Assessment or Re-Activation CS-0692 Adoptions English: <a href="https://files.dcs.tn.gov/forms/0427I.doc" target="blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0427SI.doc" target="blank">Click to Open</a> Informed Consent for Psychotropic Medication CS-0627 Relative Caregiver Program Letter of Understanding CS-0619 0930 English: <a href="https://files.dcs.tn.gov/forms/0727-1.pdf" target="_blank">Click to Open</a><br />Spanish: n/a 0817 English: <a href="https://files.dcs.tn.gov/forms/0973.doc" target="blank">Click to Open</a><br />Spanish: n/a 0813 0934 0935 English: <a href="https://files.dcs.tn.gov/forms/0672.doc" target="blank">Click to Open</a><br />Spanish: n/a Tennessee KEY Mutual Assessment Process Questionnaire CS-1228 English: <a href="https://files.dcs.tn.gov/forms/0620I.doc" target="blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0620SI.doc" target="blank">Click to Open</a> Medical Self-Report CS-0707 English: <a href="https://files.dcs.tn.gov/forms/0973.pdf" target="_blank">Click to Open</a><br />Spanish: n/a English: <a href="https://files.dcs.tn.gov/forms/0831.doc" target="blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0831S.doc" target="blank">Click to Open</a> English: <a href="https://files.dcs.tn.gov/forms/0773.doc" target="blank">Click to Open</a><br />Spanish: n/a 0708 0944 English: <a href="https://files.dcs.tn.gov/forms/0594I.doc" target="blank">Click to Open</a><br />Spanish: n/a English: <a href="https://files.dcs.tn.gov/forms/0780.doc" target="blank">Click to Open</a><br />Spanish: n/a English: <a href="https://files.dcs.tn.gov/forms/0975.pdf" target="_blank">Click to Open</a><br />Spanish: n/a English: <a href="https://files.dcs.tn.gov/forms/0678.doc" target="blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0678S.doc" target="blank">Click to Open</a> English: <a href="https://files.dcs.tn.gov/forms/0669I.doc" target="blank">Click to Open</a><br />Spanish: n/a English: <a href="https://files.dcs.tn.gov/forms/0687I.doc" target="blank">Click to Open</a><br />Spanish: n/a 0831 English: <a href="https://files.dcs.tn.gov/forms/0628I.doc" target="blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0628SI.doc" target="blank">Click to Open</a> Approval of Participation-Employee Graduate Tuition Reimbursement Program English: <a href="https://files.dcs.tn.gov/forms/0980.doc" target="blank">Click to Open</a><br />Spanish: n/a English: <a href="https://files.dcs.tn.gov/forms/1227.doc" target="blank">Click to Open</a><br />Spanish: n/a 0959 English: <a href="https://files.dcs.tn.gov/forms/0319.pdf" target="_blank">Click to Open</a><br />Spanish: n/a 0836 English: <a href="https://files.dcs.tn.gov/forms/0985I.doc" target="blank">Click to Open</a><br />Spanish: n/a Initial Intake, Placement and Well-Being Information and History CS-0727 English: <a href="https://files.dcs.tn.gov/forms/0741.pdf" target="_blank">Click to Open</a><br />Spanish: n/a English: <a href="https://files.dcs.tn.gov/forms/0158.doc" target="blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0158S.doc" target="blank">Click to Open</a> English: <a href="https://stateoftennessee.formstack.com/forms/course_id_request">Click to Open</a><br />Spanish: n/a 0963 Prior Approval of PRN Psychotropic Medication CS-0628 0961 0962 Relative Caregiver Family Information CS-0618 0960 0969 Child Health English: <a href="https://files.dcs.tn.gov/forms/0629.pdf" target="_blank">Click to Open</a><br />Spanish: n/a Release from Medical Responsibility CS-0093 Early Periodic Screening Diagnosis & Treatment (EPSDT) Physical Examination CS-0708 English: <a href="https://files.dcs.tn.gov/forms/0707.doc" target="blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0707S.doc" target="blank">Click to Open</a> Foster Home Application for Parenting CS-0688 Notice of Removal of a Child from a Foster Home CS-0450 English: <a href="https://files.dcs.tn.gov/forms/1062.pdf" target="_blank">Click to Open</a><br />Spanish: n/a 0975 Research, Survey, and Grant Request Form CS-1059 0972 0973 Foster Home Performance Improvement Plan CS-0909 0970 0971 0619 English: <a href="https://files.dcs.tn.gov/forms/0688I.doc" target="blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0688SI.doc" target="blank">Click to Open</a> Medication Transfer CS-0813 0618 0978 0979 0976 0977 N/A Background Check History and IV-E Eligibility Checklist CS-0687 English: <a href="https://files.dcs.tn.gov/forms/0970I.doc" target="blank">Click to Open</a><br />Spanish: n/a English: <a href="https://files.dcs.tn.gov/forms/0669.pdf" target="_blank">Click to Open</a><br />Spanish: n/a Legal English: <a href="https://files.dcs.tn.gov/forms/0431I.doc" target="blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0431SI.doc" target="blank">Click to Open</a> English: <a href="https://files.dcs.tn.gov/forms/1018.doc" target="blank">Click to Open</a><br />Spanish: n/a TFACTS Access Request for Providers CS-0944 English: <a href="https://files.dcs.tn.gov/forms/0836.pdf" target="_blank">Click to Open</a><br />Spanish: n/a English: <a href="https://files.dcs.tn.gov/forms/0083BI.pdf" target="_blank">Click to Open</a><br />Spanish: n/a 0985 0983 0984 0981 0982 0980 Production Job Set Up CS-0935 Program Agreement - MSW-MSSW Tuition Assistance Program CS-0983 English: <a href="https://files.dcs.tn.gov/forms/0929.doc" target="blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0929S.doc" target="blank">Click to Open</a> 0749 0628 0629 English: <a href="https://files.dcs.tn.gov/forms/0961.pdf" target="_blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0961S.pdf" target="_blank">Click to Open</a> English: <a href="https://files.dcs.tn.gov/forms/0963.doc" target="blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0963S.doc" target="blank">Click to Open</a> Help Desk Ticket Request for Providers CS-0780 English: <a href="https://files.dcs.tn.gov/forms/0981.doc" target="blank">Click to Open</a><br />Spanish: n/a English: <a href="https://files.dcs.tn.gov/forms/0450.doc" target="blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0450S.doc" target="blank">Click to Open</a> English: <a href="https://files.dcs.tn.gov/forms/0969.pdf" target="_blank">Click to Open</a><br />Spanish: n/a Application - DCS Tuition Assistance Program MSW-MSSW Program CS-0976 English: <a href="https://files.dcs.tn.gov/forms/0963I.doc" target="blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0963SI.doc" target="blank">Click to Open</a> English: <a href="https://files.dcs.tn.gov/forms/0994.doc" target="blank">Click to Open</a><br />Spanish: n/a English: <a href="https://files.dcs.tn.gov/forms/0927I.doc" target="blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0927SI.doc" target="blank">Click to Open</a> English: <a href="https://files.dcs.tn.gov/forms/1228.pdf" target="_blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/1228S.pdf" target="_blank">Click to Open</a> Special or Extraordinary Rate Request CS-0674 English: <a href="https://files.dcs.tn.gov/forms/0973I.doc" target="blank">Click to Open</a><br />Spanish: n/a Confirmation of Review of Runaway Prevention Plan CS-0910 Deferral Request - DCS Tuition Assistance Program CS-0979 English: <a href="https://files.dcs.tn.gov/forms/0909I.doc" target="blank">Click to Open</a><br />Spanish: n/a English: <a href="https://files.dcs.tn.gov/forms/0594.doc" target="blank">Click to Open</a><br />Spanish: n/a 0994 0871 English: <a href="https://files.dcs.tn.gov/forms/0677I.doc" target="blank">Click to Open</a><br />Spanish: n/a English: <a href="https://files.dcs.tn.gov/forms/0761.doc" target="blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0761S.doc" target="blank">Click to Open</a> English: <a href="https://files.dcs.tn.gov/forms/0817I.doc" target="blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0817SI.doc" target="blank">Click to Open</a> English: <a href="https://files.dcs.tn.gov/forms/0618.doc" target="blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0618S.doc" target="blank">Click to Open</a> Program Evaluation English: <a href="https://files.dcs.tn.gov/forms/0513I.doc" target="blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0513SI.doc" target="blank">Click to Open</a> 0998 English: <a href="https://files.dcs.tn.gov/forms/0707I.doc" target="blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0707SI.doc" target="blank">Click to Open</a> Initial Approval of Participation Request CS-1103 Notification of Equal Access to Programs CS-0158 English: <a href="https://files.dcs.tn.gov/forms/1045.doc" target="blank">Click to Open</a><br />Spanish: n/a 0890 Training English: <a href="https://files.dcs.tn.gov/forms/0971I.doc" target="blank">Click to Open</a><br />Spanish: n/a English: <a href="https://files.dcs.tn.gov/forms/0930I.doc" target="blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0930SI.doc" target="blank">Click to Open</a> English: <a href="https://files.dcs.tn.gov/forms/0978.doc" target="blank">Click to Open</a><br />Spanish: n/a English: <a href="https://files.dcs.tn.gov/forms/0319.doc" target="blank">Click to Open</a><br />Spanish: n/a English: <a href="https://files.dcs.tn.gov/forms/0676I.doc" target="blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0676SI.doc" target="blank">Click to Open</a> English: <a href="https://files.dcs.tn.gov/forms/0836I.doc" target="blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0836SI.doc" target="blank">Click to Open</a> English: <a href="https://files.dcs.tn.gov/forms/0702.doc" target="blank">Click to Open</a><br />Spanish: n/a English: <a href="https://files.dcs.tn.gov/forms/0921.pdf" target="_blank">Click to Open</a><br />Spanish: n/a Performance Based Contractor (PBC) Sub-Contractor CS-0969 English: <a href="https://files.dcs.tn.gov/forms/0705.pdf" target="_blank">Click to Open</a><br />Spanish: n/a Appeal for Fair Hearing by State Department CS-0403 English: <a href="https://files.dcs.tn.gov/forms/0970.pdf" target="_blank">Click to Open</a><br />Spanish: n/a English: <a href="https://files.dcs.tn.gov/forms/1230I.doc" target="blank">Click to Open</a><br />Spanish: n/a Foster Home Addendum CS-0773 Juvenile Offender Penalty for Harboring Notice CS-0749 English: <a href="https://files.dcs.tn.gov/forms/0619.pdf" target="_blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0619S.pdf" target="_blank">Click to Open</a> 0780 English: <a href="https://files.dcs.tn.gov/forms/0206.doc" target="blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0206S.doc" target="blank">Click to Open</a> English: <a href="https://files.dcs.tn.gov/forms/1100.doc" target="blank">Click to Open</a><br />Spanish: n/a English: <a href="https://files.dcs.tn.gov/forms/0691.doc" target="blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0691S.doc" target="blank">Click to Open</a> Authorization of Release of Information and HIPAA PHI To or From DCS and Notification of Release CS-0559 English: <a href="https://files.dcs.tn.gov/forms/0692I.doc" target="blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0692SI.doc" target="blank">Click to Open</a> 0778 English: <a href="https://files.dcs.tn.gov/forms/0553.pdf" target="_blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0553S.pdf" target="_blank">Click to Open</a> Child/Youth Placement and Well-Being Information CS-0727-1 Referral for Home Study Service CS-1100 Tennessee KEY Assessment CS-1227 Information Services Customer Request CS-0669 English: <a href="https://files.dcs.tn.gov/forms/0960I.doc" target="blank">Click to Open</a><br />Spanish: n/a Relative Caregiver English: <a href="https://files.dcs.tn.gov/forms/0627I.doc" target="blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0627SI.doc" target="blank">Click to Open</a> English: <a href="https://files.dcs.tn.gov/forms/RelCareProgBrochure.pdf" target="_blank">Click to Open</a><br />Spanish: n/a English: <a href="https://files.dcs.tn.gov/forms/0910.pdf" target="_blank">Click to Open</a><br />Spanish: n/a Program Agreement - DCS Employee Graduate Tuition Reimbursement Program CS-1019 0669 English: <a href="https://files.dcs.tn.gov/forms/0403.doc" target="blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0403S.doc" target="blank">Click to Open</a> English: <a href="https://files.dcs.tn.gov/forms/0619I.doc" target="blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0619SI.doc" target="blank">Click to Open</a> English: <a href="https://files.dcs.tn.gov/forms/0975.doc" target="blank">Click to Open</a><br />Spanish: n/a English: <a href="https://files.dcs.tn.gov/forms/0979.pdf" target="_blank">Click to Open</a><br />Spanish: n/a English: <a href="https://files.dcs.tn.gov/forms/0962I.doc" target="blank">Click to Open</a><br />Spanish: n/a English: <a href="https://files.dcs.tn.gov/forms/0985.doc" target="blank">Click to Open</a><br />Spanish: n/a TN Bureau of Investigation (TBI) Missing Child Report BI-0083 English: <a href="https://files.dcs.tn.gov/forms/0778.doc" target="blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0778S.doc" target="blank">Click to Open</a> English: <a href="https://files.dcs.tn.gov/forms/0674.doc" target="blank">Click to Open</a><br />Spanish: n/a English: <a href="https://files.dcs.tn.gov/forms/0978.pdf" target="_blank">Click to Open</a><br />Spanish: n/a 0678 English: <a href="https://files.dcs.tn.gov/forms/0684.doc" target="blank">Click to Open</a><br />Spanish: n/a English: <a href="https://files.dcs.tn.gov/forms/1017.doc" target="blank">Click to Open</a><br />Spanish: n/a 0439 0319 Incident Debriefing CS-0890 0559 English: <a href="https://files.dcs.tn.gov/forms/0460.doc" target="blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0460S.doc" target="blank">Click to Open</a> English: <a href="https://files.dcs.tn.gov/forms/0977.pdf" target="_blank">Click to Open</a><br />Spanish: n/a English: <a href="https://files.dcs.tn.gov/forms/1230.pdf" target="_blank">Click to Open</a><br />Spanish: n/a 0691 0692 English: <a href="https://files.dcs.tn.gov/forms/0513.doc" target="blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0513S.doc" target="blank">Click to Open</a> Database Search Results CS-0741 0688 English: <a href="https://files.dcs.tn.gov/forms/1103.doc" target="blank">Click to Open</a><br />Spanish: n/a 0689 Training Course ID Request 0687 0684 English: <a href="https://files.dcs.tn.gov/forms/0691.pdf" target="_blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0691S.pdf" target="_blank">Click to Open</a> English: <a href="https://files.dcs.tn.gov/forms/0708.doc" target="blank">Click to Open</a><br />Spanish: n/a English: <a href="https://files.dcs.tn.gov/forms/0727.docx" target="blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0727S.docx" target="blank">Click to Open</a> English: <a href="https://files.dcs.tn.gov/forms/1053.pdf" target="_blank">Click to Open</a><br />Spanish: n/a Foster Parent Pre-Service Refresher Training Plan CS-1229 English: <a href="https://files.dcs.tn.gov/forms/1217.pdf" target="_blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/1217S.pdf" target="_blank">Click to Open</a> English: <a href="https://files.dcs.tn.gov/forms/0727-1I.doc" target="blank">Click to Open</a><br />Spanish: n/a English: <a href="https://files.dcs.tn.gov/forms/1033I.doc" target="blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/1033SI.doc" target="blank">Click to Open</a> English: <a href="https://files.dcs.tn.gov/forms/0677.doc" target="blank">Click to Open</a><br />Spanish: n/a Shared Home Authorization CS-0672 English: <a href="https://files.dcs.tn.gov/forms/1059.pdf" target="_blank">Click to Open</a><br />Spanish: n/a English: <a href="https://files.dcs.tn.gov/forms/0972.doc" target="blank">Click to Open</a><br />Spanish: n/a English: <a href="https://files.dcs.tn.gov/forms/1231I.doc" target="blank">Click to Open</a><br />Spanish: n/a English: <a href="https://files.dcs.tn.gov/forms/0982.doc" target="blank">Click to Open</a><br />Spanish: n/a English: <a href="https://files.dcs.tn.gov/forms/0971.pdf" target="_blank">Click to Open</a><br />Spanish: n/a English: <a href="https://files.dcs.tn.gov/forms/1079I.doc" target="blank">Click to Open</a><br />Spanish: n/a English: <a href="https://files.dcs.tn.gov/forms/0687.doc" target="blank">Click to Open</a><br />Spanish: n/a Border Agreement Non-Custodial Consent for Transportation CS-0929 English: <a href="https://files.dcs.tn.gov/forms/0727-1.docx" target="blank">Click to Open</a><br />Spanish: n/a English: <a href="https://files.dcs.tn.gov/forms/0972.pdf" target="_blank">Click to Open</a><br />Spanish: n/a Foster Home Extension Request CS-1018 English: <a href="https://files.dcs.tn.gov/forms/0689.doc" target="blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0689S.doc" target="blank">Click to Open</a> English: <a href="https://files.dcs.tn.gov/forms/1039.doc" target="blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/1039S.doc" target="blank">Click to Open</a> English: <a href="https://files.dcs.tn.gov/forms/0961-1.doc" target="blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0961-1S.doc" target="blank">Click to Open</a> Application - DCS Employee Graduate Tuition Reimbursement Program English: <a href="https://files.dcs.tn.gov/forms/0944.pdf" target="_blank">Click to Open</a><br />Spanish: n/a Home Safety Checklist CS-0676 Relative Caregiver Program Referral CS-1230 0583 English: <a href="https://files.dcs.tn.gov/forms/0422.doc" target="blank">Click to Open</a><br />Spanish: n/a English: <a href="https://files.dcs.tn.gov/intranet/forms/0093.doc" target="blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0093S.doc" target="blank">Click to Open</a> Transfer, Mail and Acknowledgment of Case Records, Record Materials and Forms CS-0422 English: <a href="https://na1.documents.adobe.com/public/esignWidget?wid=CBFCIBAA3AAABLblqZhDd1Zsp0me4WEqPPhsD-eWrZ50d_0R0W9pUUUQ_CA8uZ8KbKXFf8tyAt0ITrJiBceE">Click to Open</a><br />Spanish: n/a English: <a href="https://files.dcs.tn.gov/forms/0628.doc" target="blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0628S.doc" target="blank">Click to Open</a> Application for Service as a Volunteer CS-0319 English: <a href="https://files.dcs.tn.gov/forms/0427.pdf" target="_blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0427S.pdf" target="_blank">Click to Open</a> English: <a href="https://files.dcs.tn.gov/forms/0553.doc" target="blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0553S.doc" target="blank">Click to Open</a> English: <a href="https://files.dcs.tn.gov/forms/0619.doc" target="blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0619S.doc" target="blank">Click to Open</a> Contract Agency Curriculum Review CS-1053 Application for Re-establishment of Foster Care Services CS-0778 English: <a href="https://files.dcs.tn.gov/forms/0614I.doc" target="blank">Click to Open</a><br />Spanish: n/a English: <a href="https://files.dcs.tn.gov/forms/1062.doc ">Click to Open</a><br />Spanish: n/a Americans with Disability Act (ADA) Complaint CS-1093 Notification Checklist for Absconders/Runaways/Escapees CS-0705 0594 English: <a href="https://files.dcs.tn.gov/forms/0439I.doc" target="blank">Click to Open</a><br />Spanish: <a href="https://files.dcs.tn.gov/forms/0439SI.doc" target="blank">Click to Open</a> English: <a href="https://files.dcs.tn.gov/forms/1231.doc" target="blank">Click to Open</a><br />Spanish: n/a English: <a href="https://files.dcs.tn.gov/forms/0910I.doc" target="blank">Click to Open</a><br />Spanish: n/a