OMB Control No.: xxxx-xxxx
Expiration Date: xx/xx/20xx
THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) Public reporting burden for this collection of information is estimated to average 105 minutes per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number.
[Official Tribe Name]
[Date]
Legal and Judicial |
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Yes |
No |
Operates own tribal court |
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Hears criminal child welfare matters |
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Hears civil child welfare matters |
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Written criminal Children’s Code Last amended: |
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Written civil Children’s Code Last amended: |
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Offers clear definitions of child abuse and neglect |
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Offers procedural guidelines of investigations of complaints |
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Court provides notifications to foster parents and relatives |
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Who provides notification? |
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Civil Children’s Code addresses custody rights of parents and TPR |
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Civil Children’s Code allows for customary adoption |
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Legal advocate to provide representation for the following in tribal court: |
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Tribal CASA or GAL in place |
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Additional Comments:
Child Welfare Program Services |
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Yes |
No |
Title IV-B funding, Part I |
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Tribal IV-B funding, Part 2 |
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Tribal/state IV-E agreement in place |
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If yes, Administrative reimbursement funds |
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If yes, Maintenance reimbursement payments |
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If yes, Training reimbursement funds |
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Tribal Title IV-E development grant completed and Title IV-E plan approved |
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Direct Title IV-E program operational |
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Operates tribal child welfare program
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Additional Comments:
Family Preservation |
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Placement prevention services |
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In-home services |
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What agency provides prevention or in-home services? |
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Family Preservation Policies and procedures in place |
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Prevention Services Provided:
CPS Investigations |
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CPS Manager Name
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What agency provides investigation services? |
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Yes |
No |
Risk/safety assessment tool used |
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CPS Policies and procedures in place for law enforcement |
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ICWA |
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ICWA Program Manager
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ICWA program in place |
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ICWA Policies and procedures in place |
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Tribal/state ICWA agreement in place |
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Who makes ICWA intervention decisions? |
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Additional Comments:
Resource Families |
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Resource Family Manager
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Tribe licenses foster and kinship homes |
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License off-reservation |
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Licensing standards in place? |
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What areas of licensing do codes cover? |
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Formal foster recruitment/retention plan in place |
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Is foster parent training available? describe |
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Provides guardianship/adoption services |
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Policies and procedures for adoption/guardianship |
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Who is responsible for recruitment and licensing? |
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Additional Comments:
Youth Services |
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Youth Services Manager
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Yes |
No |
Independent living services available for youth? Provided by State/County/Tribe/Other
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Other available services for youth (drop down) – mental health, transitional living, mental, cultural, tutoring, recreation, educational, job training, child care, transportation, food, clothing |
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File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Temp |
File Modified | 0000-00-00 |
File Created | 2021-01-24 |