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file will include any original documents or signatures and all supportive documents required under the ICPC, which upon closure, is an official record of ICPC activities to be maintained per TN DCS Records Disposition Authority (RDA) policies.


The TN ICPC Administrator/Alternate maintains a duplicate paper “working” file with copies of all ICPC documents per each child involved in an active ICPC transaction, which upon closure of the ICPC instance is destroyed as outlined in TN DCS RDA policies.


Pending initiation of the Referral and the issuance of a written decision by the Receiving State ICPC Administrator regarding placement of the child with that out-of-state resource, the TN DCS Regional staff is not authorized to place the child across state lines under the ICPC.  The TN DCS Regional staff is responsible to maintain the child in an intra-state placement pending determination of appropriateness of the out-of-state resource per the ICPC. Exception to a placement prior to issuance of a written decision by the Receiving State ICPC Administrator regarding an inter-jurisdictional placement may be made under specific provisions outlined in ICPC Regulation #1, Conversion of Intrastate Placement (TN) into Interstate Placement; Relocation of Family Unit (Refer to Section 1, B: Unique Referrals) or under the explicit and limited provisions outlined in a Border Agreement into which the TN DCS has entered (Refer to  Appendix: B - Border Agreements).


Unless otherwise specified in Section I, B. Unique Referrals or Appendix B, Border Agreements. ICPC Referral packets which involve a child in the custody/guardianship of the Tennessee Department of Children’s Services  must  contain the following documents as a  minimum to be considered complete:  


An ICPC Referral Checklist (CS-0796)


An 100A form Interstate Compact Placement Request (CS-0525) accurately completed and signed/dated.


Cover Letter (Per Sample in Appendix B and forms CS-0958 Placement Resource Statement of Confirmation ICPC Reg. #2 or CS-0957 Placement Resource Statement of Confirmation Reg. #7 and Border Agreement)


Current Family Functional Assessment (CS-0777) as appropriate.    


Permanency Plan in TFACTS or form CS-0577 Permanency Plan-Spanish version.  Either handwritten signed/dated copy or court ratified copy; including any revisions and/or supplemental or supporting plans, such as Independent Living Plan or Planned Permanent Living Arrangements (CS-0681-Request for Permanency Goal of Planned Permanent Living Arrangement) or Treatment Plan as appropriate.    


Current Custody/Guardianship Order and other pertinent court documents (signed and dated) plus previous petitions, custodial order, the required annual Court review for permanency plan (or equivalent) which reaffirms “reasonable efforts” and if appropriate, court documents regarding delinquency adjudications, visitation limitations, termination proceeding and any “no contact orders”.


ICPC Medical-Financial Plan (CS-0795) and appropriate supporting documents.  Primary supporting documents to be attached include the Notice of Child Welfare Benefits Summary for Custodial Child (CS-0508) or signed and dated written agreement from placement resource to meet the financial and/ or medical needs of the child.  Other attachments as applicable may be required including but not limited to Child Welfare Benefits Re-determination (CS-0477), Subsidized Permanent Guardianship Agreement (CS-0721) and Adoption Assistance Agreement (CS-0513).   

The Interstate Compact on the Placement of Children Procedures Manual

Revised: January, 2012                                                                                                                           Page 15

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