Form 1 Center for Tribes Demographic Survey

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
	Yes	No
Operates own tribal court
Hears criminal child welfare matters
Hears civil child welfare matters
Written criminal Children’s Code Last amended:
Written civil Children’s Code Last amended:
Offers clear definitions of child abuse and neglect
Offers procedural guidelines of investigations of complaints
Court provides notifications to foster parents and relatives
Who provides notification?
Civil Children’s Code addresses custody rights of parents and TPR
Civil Children’s Code allows for customary adoption
Legal advocate to provide representation for the following in tribal court:
Parents
Child
Child Welfare staff
Relatives
Tribal CASA or GAL in place

Additional Comments:

Child Welfare Program Services
	Yes	No
Title IV-B funding, Part I
Tribal IV-B funding, Part 2
Tribal/state IV-E agreement in place
If yes, Administrative reimbursement funds
If yes, Maintenance reimbursement payments
If yes, Training reimbursement funds
Tribal Title IV-E development grant completed and Title IV-E plan approved
Direct Title IV-E program operational
Operates tribal child welfare program
Child protection investigations
Foster care recruitment
Foster placements
Permanency planning
Case management
Adoptions (including customary adoption)
Guardianship
ICWA

Additional Comments:

Family Preservation
Placement prevention services
In-home services
What agency provides prevention or in-home services?
Family Preservation Policies and procedures in place

Prevention Services Provided:

CPS Investigations
CPS Manager Name
What agency provides investigation services?
	Yes	No
Risk/safety assessment tool used
CPS Policies and procedures in place for law enforcement

ICWA
ICWA Program Manager
ICWA program in place
ICWA Policies and procedures in place
Tribal/state ICWA agreement in place
Who makes ICWA intervention decisions?

Additional Comments:

Resource Families
Resource Family Manager
Tribe licenses foster and kinship homes
License off-reservation
Licensing standards in place?
What areas of licensing do codes cover?
Formal foster recruitment/retention plan in place
Is foster parent training available? describe
Provides guardianship/adoption services
Policies and procedures for adoption/guardianship
Who is responsible for recruitment and licensing?

Additional Comments:

Youth Services
Youth Services Manager
	Yes	No
Independent living services available for youth? Provided by State/County/Tribe/Other
Other available services for youth (drop down) – mental health, transitional living, mental, cultural, tutoring, recreation, educational, job training, child care, transportation, food, clothing