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Foster Care Licensing Forms

Family Foster Home Forms
FCL000​   Release of Compliance History *Updated 09/2021
FCL000S Release of Compliance History in Spanish
FCL001   Compliance Action Plan
FCL001S Compliance Action Plan in Spanish
FCL004   NOSF for Sponsoring Agency
FCL007   Request for Program Review
FCL007S Request for Program Review in Spanish
FCL401   Family Foster Home Application *Updated 03/2022
FCL401S Family Foster Home Application in Spanish
FCL402   Family Foster Home Renewal Application *Updated 09/2021
FCL402S Family Foster Home Renewal Application in Spanish
FCL403​   Family Foster Home Survey Instrument
FCL403S Family Foster Home Survey Instrument in Spanish
FCL406   Family Foster Home Request to Close *Updated 03/2022
FCL406S​ Family Foster Home Request to Close in Spanish
FCL407​   Family Foster Home Request for Amendment *Updated 03/2022
FCL408   Foster Family Home Exception Request​ *Updated 09/2021
FCL655   Request for Transfer of Sponsoring Child Placement Agency (CPA)
FCL655S Request for Transfer of Sponsoring Child Placement Agency (CPA) in Spanish  
FCL656​   Child Placing Agency (CPA) Withdrawal of Sponsorship
Agency/Facility Forms
FCL000   Release of Compliance History
FCL000S​ Release of Compliance History in Spanish
FCL001   Compliance Action Plan
FCL001S Compliance Action Plan in Spanish
FCL004   Notice Of Survey Findings (NOSF) for Sponsoring Agency *Updated 09/2021
FCL007   Request for Program Review
FCL007S​ Request for Program Review in Spanish
FCL051   Application for Facilities
FCL057   Amendment for Facilities
FCL058​   Request for Exception for Facilities​ *Updated 09/2021
FCL100​   Request to Withdraw Application *New 09/2021
FCL200   Group Boarding Home (GBH) and Residential Center (RC) Annual Training Log for Non-Providers *New 09/2021
FCL201   Group Boarding Home (GBH) and Residential Center (RC) Annual Training Log for Providers *New 09/2021
FCL202   Group Boarding Home (GBH) and Residential Center (RC) New Hire Training Log for Providers *New 09/2021
FCL203   Group Boarding Home (GBH) and Residential Center (RC)​ New Hire Training Log for Non-Providers *New 09/2021
FCL204   Detention and Secure Care Annual Training Log *New 09/2021
FCL205​   Detention and Secure Care New Hire Training Log *New 09/2021​
FCL651   CPA Application *Updated 09/2021
FCL652   Amendment for CPA
FCL656​   CPA Withdrawal of Sponsorship
FCL657   CPA Request for Exception​
FCL658   NRKIN Expedited Application
FCL659   Relative Waiver
FCL659S​ Relative Waiver in Spanish
FCL750​   Request to Close a Licensed Facility or CPA
Background Check Forms
FCL002        Individual Background Check *Updated 03/2022
FCL002S      Individual Background Check in Spanish *New 09/2021
Optional Forms
FCL005   Yearly Mechanical Safety Check​
FCL009   Health Assessment 16 & Older
FCL010   Authorization For Emergency Medical Care  *New 03/2022  
FCL011   Fire and Tornado Drill Record  *Updated 09/2021
FCL030​   Regulatory Complaint Intake
FCL054   Continuous Dental Care  *New 03/2022
FCL059​   Health Assessment for Foster Parents' Children
FCL300   Foster Family Budget
FCL404​   Sample Menu
FCL405   Family Foster Home Self Evaluation  
FCL410   Book or Video Report
FCL410S Book or Video Report in Spanish

​Guidance Documents
FCL002 Guidance Document  *New 03/2022