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for family permanency plan  which reaffirms “reasonable efforts”  and if appropriate, court documents regarding delinquency adjudications, visitation limitations and any “no contact orders”.  Include any order that authorizes the child to be placed outside the jurisdiction of the court.    


ICPC Medical-Financial Plan (CS-0795) and appropriate supporting documents.  Primary supporting documents to be attached include the Notice of Child Welfare Benefit 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.   However, 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).  


Current Educational Passport and School Enrollment Letter (CS-0657) and supporting documents including Individual Education Plan, Social Security Card and Birth Certificates.    


TFACTS Health Summary and supporting documents.  


Current approved or valid resource home study/re-assessments including all documents such as Criminal history/ fingerprint results documented for no less the period of 5 years prior.  


Form ICPC 100B, Interstate Compact Report on Child’s Placement Status (CS-0523) which specifies the date that the child/resource family relocated and the address to which the family and child relocated.   


Purchase of Services Agreement, signed and dated if negotiated.   

C.  TN DCS Custodial Placement: ICPC Regulation #7 Expedited Placement Decision Referral:

In order to address delays in the placement of children who are under the age of 4  years or in an emergency intra-state placement due to unexpected dependency or are part of a sibling group who are documented as having spent substantial amount of time in the home of the  specific class of placement resources, the sending state agency and the sending state court will partner to submit an ICPC referral under Regulation #7  Expedited Placement Decision.

ICPC Regulation #7 Expedited Placement Decision process does not apply if the request for placement of the child is for licensed or approved foster family care as a preliminary to an adoption or adoption or the child is already in placement in the receiving state in violation of the ICPC.  


Whenever TN DCS Regional staff  determines through an appropriate CFTM that an out-of-state placement of TN DCS custodial child or children who meet the criteria cited above with a placement resource defined under Article VIII (a) as  relative , specifically parent, stepparent, grandparent, adult brother or sister, adult uncle or aunt or  guardian as defined under the ICPC Regulation #10 is necessary, the TN DCS Regional staff  will coordinate with the Tennessee court of jurisdiction to execute, sign and date an ICPC Regulation #7 Expedited Placement Decision order finding entitlement to an expedited   placement.  The Tennessee court of jurisdiction will submit the ICPC Regulation #7 Expedited Placement Decision order to the TN DCS Regional staff within two (2) business days as prescribed in the Regulation.

The Interstate Compact on the Placement of Children Procedures Manual

Revised: January, 2012                                                                                                                           Page 18

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