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ICPC 100A - Interstate Compact Placement Request (CS-0525) accurately completed and signed/dated;   


Cover Letter (Per Sample in Appendix B);


Current custody/guardianship order and other pertinent court documents (signed and dated) including previous petitions, custodial orders, the required annual court review for family permanency plan (or equivalent) which reaffirms “reasonable efforts”  and if appropriate, court documents regarding delinquency adjudications, visitation limitations, terminations and any “no contact orders”.   


ICPC Medical-Financial Plan (CS-0795) and appropriate supporting documents.  Primary supporting documents for placement of a custodial child into an RTC for treatment is documentation of approved fee payment negotiated by the TN DCS Office of Child Placement and Private Providers pursuant to the Unique Care Agreement.   In addition, supporting documentation regarding the child’s eligibility under IV-e or SSI -the Notice of Child Welfare Benefit Summary for Custodial Child (CS-0508)  or Child Welfare Benefits Re-determination (CS-0477).


Letter of Acceptance of the child into the RTC on RTC letterhead.  



Per ICPC Regulation #5:  all Interstate referrals and resultant ICPC documents and other matters to and from the State of Tennessee shall be made through the TN DCS State ICPC office.  Accordingly, the TN ICPC Administrator/Alternate is responsible to process all interstate referrals and resultant documents to the designated central office of each of the party states or the identified county office of the states of California and Colorado and Ohio as well as with “sending agents” in the State of TN.   The TN ICPC Administrator/Alternate will maintain records on all ICPC transactions within the TFACTS.


TN ICPC Administrator/Alternate will review all referrals and resultant ICPC documents received from appropriate “sending agents” and determine completeness of all required documents as well as determine appropriateness of the authorizing signatures.


TN ICPC Administrator/Alternate will enter and/or manage a centralized ICPC database in the TFACTS, supplanted by a database in  ACCESS as well as maintain a centralized working paper file on each child involved in an ICPC record while active.  


If additional information is needed before a Referral or other documents can be processed to a receiving state, the TN ICPC Administrator/Alternate will notify the TN DCS Regional staff, utilizing the ICPC transmittals/scan/email/mail and/or TFACTS.  


Additional information requested is scanned/e-mailed or mailed to the TN DCS State ICPC office to the designated TN ICPC Administrator/Alternate within ten (10) business days or less by the TN DCS Regional staff.  


If the sending agent does not have access to the TFACTS, the information will be entered in the TFACTS by the appropriate TN ICPC Administrator/Alternate upon receipt in the TN DCS State ICPC office.


If the requested information is not provided within ten (10) working days by the TN DCS Regional staff, or a written notice documenting the reason the information or documents are not available and a proposed date as to when they may be available, the TN ICPC Administrator/Alternate will return the referral packet to the TN DCS Regional staff; the Referral will be void; closed and documented as such in the TFACTS. The ICPC Administrator/Alternate will pursue other documents not provided after an initial request

The Interstate Compact on the Placement of Children Procedures Manual

Revised: January, 2012                                                                                                                           Page 21

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