CMS-07-021/023 - Los Angeles County Department of Children and ...

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education binders. have completed and current health/education binders, as requested by Welfare and Institutions Code Section 16010, during the placement period. 9 Educational performance is defined as improved grades and/or improved test scores and/promotion to the next level and/or high school graduation and/or progress towards IEP goals, if applicable, for those children who have been placed at the Group Home over 90 Days. Attendance is based on previous school attendance records and/or the Group Home education assessment at placement. 30
3.0 WELL-BEING PERFORMANCE OUTCOME GOAL: Placed Children shall improve their level of functioning in the areas of education, health, behavior, and social and emotional well-being. SERVICE TASKS: 3.1 Intake Requirements: 3.1.1 Pre-Placement Duties: The CONTRACTOR shall: (a) request information from the County Worker in conformity with DCFS/Probation policy and confidentiality laws regarding the referred child’s/children’s needs, including copies of all court reports and social studies; (b) request from County Worker information regarding any known or suspected dangerous behavior of the referred child; (c) discuss the type of Services the referred child requires; (d) provide the County Worker information relating to any child abuse/neglect referrals and/or allegations which have been made concerning the proposed GH site/staff and describe what action the CONTRACTOR has taken in response to such referrals/allegations. (e) arrange for a child/children referred for placement to a visit to the proposed GH site prior to the child's/children’s placement whenever possible; (f) discuss with County Worker the children currently living in the proposed GH site, including ages, backgrounds, and placing agencies; (g) discuss with both the County Worker and referred child(ren), when age appropriate, the school programs, social work Services, and recreational activities that are available (h) discuss with County Worker the transportation arrangement if the person holding the right to make educational decisions plans for the referred child to continue in the school of origin; 3.1.2 Assessment and Acceptance of Referred Children: (a) The CONTRACTOR’S social work staff shall assess the program’s ability to: (1) provide the required Services to meet the referred child’s needs based upon the information received from the referred child’s County Worker; and (2) facilitate family participation in treatment, as 31
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DEPARTMENT OF CHILDREN AND FAMILY S
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REQUEST FOR STATEMENT OF QUALIFICAT
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1.0 INTRODUCTION 1.1 Preamble For o
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COUNTY agencies and their partners
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1.3 DCFS Mission Statement DCFS wil
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2.0 GENERAL INFORMATION 2.0 Scope o
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2.4.1.2 Prospective Contractor must
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old for 30 days or less; (3) provid
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Contractor protest. In all cases, t
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2.19 Conflict of Interest No County
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submit evidence at that hearing. Af
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solicitation may result in the pros
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County’s contracting process by c
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2.33 Contractor’s Charitable Cont
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3.0 Instructions to Prospective Con
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The request for a Solicitation Requ
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3.7.1 Language The SOQ and all docu
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coverage should the prospective Con
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3.8.6 Please refer to Section 3.0 I
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4.0 SOQ REVIEW/SELECTION/QUALIFICAT
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The Department will execute Board o
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19 20 21 22 List of Required Forms
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CONTRACTOR’S ORGANIZATION QUESTIO
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CONTRACTOR’S ORGANIZATION QUESTIO
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VENDOR’S EEO CERTIFICATION REQUIR
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REQUIRED FORMS - FORM 5 FAMILIARITY
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PROSPECTIVE CONTRACTOR LIST OF TERM
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REQUIRED FORMS - FORM 9 COUNTY OF L
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REQUIRED FORMS - FORM 11 OFFER TO P
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CERTIFICATION OF FISCAL COMPLIANCE
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LIST OF COMMITMENTS Legal Name of A
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REQUIRED FORMS - FORM 17 CONTRACTOR
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CERTIFIED FOSTER PARENT CONFIDENTIA
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CONTRACTOR’S EMPLOYEE ACKNOWLEDGE
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Type of program: Foster Family Agen
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CONTRACTOR’S NAME: CONTRACT NO. N
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REQUEST FOR STATEMENT OF QUALIFICAT
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TRANSMITTAL FORM TO REQUEST A RFSQ
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APPENDIX E LISTING OF CONTRACTORS D
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SAMPLE CONTRACT COUNTY OF LOS ANGEL
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LIST OF EXHIBITS SAMPLE CONTRACT Ex
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SAMPLE CONTRACT Exhibit A-IX Requir
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as a single process. SAMPLE CONTRAC
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SAMPLE CONTRACT 2.27 “Foster Care
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SAMPLE CONTRACT written in accordan
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SAMPLE CONTRACT Such insurance shal
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SAMPLE CONTRACT 6.0 INSURANCE COVER
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SAMPLE CONTRACT partial, and supple
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SAMPLE CONTRACT 7.15 Provided that
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10.0 COUNTY’S RESPONSIBILITY SAMP
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SAMPLE CONTRACT 10.13 The CSWs shal
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SAMPLE CONTRACT and/or Certified Fo
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SAMPLE CONTRACT Investigation/Monit
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SAMPLE CONTRACT will also invite CO
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SAMPLE CONTRACT 18.4 The CONTRACTOR
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SAMPLE CONTRACT management review,
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SAMPLE CONTRACT 20.2 CONTRACTOR and
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SAMPLE CONTRACT 22.2 CONTRACTOR her
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SAMPLE CONTRACT notice by the CONTR
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SAMPLE CONTRACT COUNTY’s prior wr
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SAMPLE CONTRACT FOSTER FAMILY AGENC
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SAMPLE CONTRACT to the Contract, wh
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SAMPLE CONTRACT governing or impact
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8.0 GRIEVANCES SAMPLE CONTRACT term
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SAMPLE CONTRACT 11.1.2 For purposes
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SAMPLE CONTRACT CONTRACTOR will int
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SAMPLE CONTRACT conduct a hearing w
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SAMPLE CONTRACT CONTRACTOR warrants
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SAMPLE CONTRACT solely of CONTRACTO
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1015, attached hereto as Exhibit L.
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SAMPLE CONTRACT 30.1.3 CONTRACTOR m
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SAMPLE CONTRACT not limited to, the
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SAMPLE CONTRACT amounts COUNTY clai
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COUNTY OF LOS ANGELES DEPARMENTS OF
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PART A: INTRODUCTION 1.0 PREAMBLE E
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EXHIBIT A COUNTY agencies and thei
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EXHIBIT A (Health and Safety Code),
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PART B: TARGET DEMOGRAPHICS 1.0 TAR
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1.0 SAFETY EXHIBIT A PERFORMANCE OU
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1.1.7 Required Services by CONTRACT
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EXHIBIT A The CONTRACTOR shall Moni
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PROGRAM TARGET GROUP: Placed Childr
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EXHIBIT A the fullest extent possib
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EXHIBIT A Monitor for Compliance th
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3.0 WELL-BEING EXHIBIT A PERFORMANC
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EXHIBIT A participation in treatmen
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EXHIBIT A individuals to the extent
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EXHIBIT A 88068.2, 88068.3, and 880
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EXHIBIT A objectives appropriate to
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EXHIBIT A The CONTRACTOR shall prov
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3.7.4 Monetary Consequences EXHIBIT
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EXHIBIT A Days. After 14 Days, the
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EXHIBIT A The CONTRACTOR shall have
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EXHIBIT A for the Placed Child to r
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EXHIBIT A specified in the Needs an
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EXHIBIT A The CONTRACTOR shall Moni
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FOSTER YOUTH BILL OF RIGHTS EXHIBIT
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EXHIBIT A-I 19. Residents have the
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EXHIBIT A-I Reprise 25. Residents s
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INTENTIONALLY LEFT BLANK EXHIBIT A-
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EXHIBIT A-IVa STATE OF CALIFORNIA
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FOSTER CHILD’S NEEDS AND CASE PLA
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AGENCY - GROUP HOME AGREEMENT Child
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EXHIBIT A-VIII SPECIAL INCIDENT REP
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5. SERIOUS INJURY, ILLNESS OR ACCID
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EXHIBIT A-VIII 10. SIGNIFICANT INCI
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SCREENING REQUIREMENT PERIODICITY S
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Anticonvulsant medications, when pr
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Dr. faxes pages 1 & 2 of PMAF to th
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EXHIBIT A-X 2. Contact the physicia
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EXHIBIT A-X 1. Instruct the caregiv
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APPROVAL LEVELS Section Level Appro
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(CSW completes top section) Los Ang
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D. Please attach a list of the foll
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TO THE HEADS OF EXECUTIVE DEPARTMEN
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implementation of individual provis
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E. Negotiation and Approval of Indi
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. The restraints or requirements im
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objectives of the organization are
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distribution base. The result of th
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special cost studies (such as an en
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other activity. The bases must be e
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g. The results of each negotiation
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49. Training costs 50. Transportati
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e. Costs identified in subparagraph
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compensation for employees on feder
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(3) Excise taxes on accumulated fun
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with certainty as to time, intensit
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appeals, antitrust suits, or the pr
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(1) Donated or volunteer services m
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(1) Capital expenditures for genera
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(2) "Idle facilities" means complet
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enovations, alterations, equipment,
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. For non-profit organizations subj
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already required or maintained. Als
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see paragraphs 37., Professional se
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41. Recruiting costs. a. Subject to
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continued to own the property. This
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48. Termination costs applicable to
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(3) Fees charges by the educational
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e. Foreign travel. Direct charges f
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Southern Research Institute, Birmin
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A-C Handbook Page 1 AUDITOR-CONTROL
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A-C Handbook Page 3 2.2 Cash Receip
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A-C Handbook Page 5 If a Payroll Re
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A-C Handbook Page 7 Outside Meals -
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A-C Handbook Page 9 CONTRACTOR shal
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A-C Handbook Page 11 2.3 Petty Cash
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A-C Handbook Page 13 Salaried emplo
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A-C Handbook Page 15 Indirect Cost
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A-C Handbook Page 17 2.3 Acceptable
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A-C Handbook Page 19 D. UNALLOWABLE
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EXHIBIT C-II AUDITOR-CONTROLLER/DEP
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• California Code of Regulations,
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If CONTRACTOR and A-C/DCFS hold a p
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XIV. Final Report to the Board of S
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EXHIBIT D Cont. I understand that I
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EXHIBIT D-I Cont. I understand that
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24. Equipment Leases 25. Depreciati
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Report all costs related to telepho
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EXHIBIT E D. Total Un-Expended AFDC
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EXHIBIT F (D) If the State Departme
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EXHIBIT F (C) Individuals who are e
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EXHIBIT F subdivision (g). The Stat
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EXHIBIT F processing. (B) Upon requ
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EXHIBIT F self-addressed envelope f
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EXHIBIT F shall disclose that clien
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EXHIBIT F state, would have been pu
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statement, fingerprints and photogr
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Name, Address and Telephone Number
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EXHIBIT G If a CSW or SCSW has any
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EXHIBIT G 10) minute orders and cou
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0500-501.20 (Rev 12/02) EXHIBIT G 4
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EXHIBIT G See Procedural Guide 0200
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EXHIBIT G that the research will no
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EXHIBIT G detrimental to the safety
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EXHIBIT G Procedural Guide 0500-504
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EXHIBIT H of changes to the plan. (
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EXHIBIT I (e) The child's caretaker
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EXHIBIT I CSW in Concurrent Plannin
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Procedures A. WHEN: A CHILD IS DETA
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B. WHEN: A CHILD IS IN OUT-OF-HOME
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Dependency Investigator CSW Respons
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EXHIBIT I For offices who have impl
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EXHIBIT I FB1 Addendum, Family Back
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CHILD WELFARE SERVICES PROGRAM 31-4
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Department of the Treasury Internal
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DCFS FOSTER FAMILY AGENCY CONTRACT
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EXHIBIT N medication authorizations
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EXHIBIT N 5. The DCFS Division Chie
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EXHIBIT O 1. The lesser number is a
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EXHIBIT O COUNTY OF LOS ANGELES CON
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CONTRACTOR’S CERTIFICATION OF COM
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F I F I F I F I EXHIBIT R F O R Y O
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8. Does the child receive the sport
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EXHIBIT R 33. Is the child given th
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Every baby deserves a chance for a
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Es mejor que las mujeres busquen ay
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• Llámenos para recibir informac
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A. WHEN: A FAD INDICATES A POTENTIA
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EXHIBIT T O/P Collection EW 4. INVA
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EXHIBIT T NOTE: Overpayment recover
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Reconciliation EW 3. Receive the Ba
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Overpayment Recovery Unit ES WHO HO
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CHARITABLE CONTRIBUTIONS CERTIFICAT
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SERVICE DELIVERY SITES Foster Famil
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TABLE OF CONTENTS INTRODUCTION/SUMM
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PURPOSE/PHILOSOPHY STATEMENT These
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TEAMING PROCESS Family-Centered Tea
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COURT ORDERS Oftentimes, the judici
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First 24 Hours Child removed from p
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FAMILY VISITATION PLAN Prior to the
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• Whether or not the parent is a
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• Maintain objectivity, and remai
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Judicial Officers Judicial Officers
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Unless the FVP specifically states
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the visitation objectives. In addit
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Sexual Abuse Permanency Transportat
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SUBCOMMITTEE MEMBERS The Drafting S
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EXHIBIT Y of information, including
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EXHIBIT Y accounting of Disclosures
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DISCHARGE SUMMARY FOR DCFS: FOSTER
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INTENTIONALLY LEFT BLANK EXHIBIT BB
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10.0 COMPLIANCE WITH CIVIL RIGHTS L
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Exhibit T Overpayments Exhibit U Gr
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WHEREAS, CONTRACTOR warrants that i
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2.0 DEFINITIONS Exhibit T Overpayme
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2.16 “Do Not Refer Status” or
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2.31 “Pool Rate” - means the ra
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notify COUNTY of such change. COUNT
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equivalent providing the CONTRACTOR
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a bed open for a Placed Child, CONT
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7.14 CONTRACTOR may appeal the fina
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9.2 If CONTRACTOR’s staff qualify
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10.11 COUNTY Workers shall provide
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13.0 FEES 12.1 CONTRACTOR shall mai
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Exhibit N, DCFS/Probation Group Hom
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16.0 FINANCIAL REPORTING 16.1 CONTR
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closing summary of CONTRACTOR's rec
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including but not limited to, the U
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19.6 Nothing herein precludes COUNT
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entirety; or (2) reduced in accorda
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accounted for and that unspent fund
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omissions, resulting from its perfo
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County of Los Angeles - Department
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4.0 BUDGET REDUCTIONS In the event
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6.2.3 The assurance that all employ
Page 517 and 518: CONTRACTOR hereby assures that it w
Page 519 and 520: 12.3 CONTRACTOR shall comply with a
Page 521 and 522: modify, deny or adopt the proposed
Page 523 and 524: minimum waiting time for clearance.
Page 525 and 526: County of Los Angeles Department of
Page 527 and 528: eject children for placement consis
Page 529 and 530: 30.0 DISCLOSURE OF INFORMATION 30.1
Page 531 and 532: 33.7 CONTRACTOR shall obtain the fo
Page 533 and 534: 35.0 TERMINATION FOR CONVENIENCE 35
Page 535 and 536: CONTRACTOR receives, has access to,
Page 537 and 538: COUNTY OF LOS ANGELES DEPARTMENT OF
Page 539 and 540: COUNTY OF LOS ANGELES DEPARTMENTS O
Page 541 and 542: • Safety and Survival; • Emotio
Page 543 and 544: Service Access Service providers wi
Page 545 and 546: The CONTRACTOR shall request approv
Page 547 and 548: Plan/Quarterly Reports in cooperati
Page 549 and 550: 6.4 The CONTRACTOR’S Treatment Te
Page 551 and 552: PART C: SERVICE TASKS TO ACHIEVE PE
Page 553 and 554: 1.0: SAFETY PERFORMANCE OUTCOME GOA
Page 555 and 556: Placed Children; and (2) abide by a
Page 557 and 558: (b) The CONTRACTOR shall use seclus
Page 559 and 560: PERFORMANCE OUTCOME SUMMARY 2.0 PER
Page 561 and 562: 2.0: REUNIFICATION/PERMANENCY PERFO
Page 563 and 564: 2.2 Visitation Plan: modification i
Page 565 and 566: (a) For infants from birth to 6 mon
Page 567: PERFORMANCE OUTCOME SUMMARY 3.0 WEL
Page 571 and 572: (b) Two children’s rights recentl
Page 573 and 574: their responsibilities to pupils in
Page 575 and 576: 3.2.8 Educational Assessments by th
Page 577 and 578: information such as immunizations g
Page 579 and 580: The CONTRACTOR shall have an emerge
Page 581 and 582: assistance with homework; (5) daily
Page 583 and 584: 3.11.5 Clothing Fit, Appropriatenes
Page 585 and 586: placed with a minor parent if the C
Page 587 and 588: PART D - PERFORMANCE REQUIREMENT SU
Page 589 and 590: FOSTER YOUTH BILL OF RIGHTS EXHIBIT
Page 591 and 592: 19. Residents have the right to con
Page 593 and 594: not prohibited by the resident's ne
Page 595 and 596: TABLE OF CONTENTS ii EXHIBIT A-II I
Page 597 and 598: OUT-OF-HOME CARE EXHIBIT A-II What
Page 599 and 600: EXHIBIT A-II What is a juvenile cou
Page 601 and 602: EXHIBIT A-II care still exist, if y
Page 603 and 604: EXHIBIT A-II Can I have an attorney
Page 605 and 606: TYPES OF PLACEMENTS EXHIBIT A-II Wh
Page 607 and 608: GUARDIANSHIP EXHIBIT A-II What is t
Page 609 and 610: INDEPENDENT LIVING EXHIBIT A-II Wha
Page 611 and 612: CONFIDENTIALITY AND YOUR RECORDS EX
Page 613 and 614: WHEN RECORDS ARE DESTROYED Juvenile
Page 615 and 616: MONEY EXHIBIT A-II Do I have a righ
Page 617 and 618: RELIGION Can my foster parents or N
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EXHIBIT A-II What if I can't get a
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EMANCIPATION EXHIBIT A-II What does
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EXHIBIT A-II What are the disadvant
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KNOW YOUR RIGHTS EXHIBIT A-II With
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DEFINITION INDEX The number refers
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ENDNOTES 1. The following abbreviat
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35. WIC 317(c) 36. WIC 317(d),(e) E
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84. VC 12814.6 85. VC 17701 86. FC
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PROBATION CASE PLAN FORM (PROB 1385
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EXHIBIT A-V 1. Describe Circumstanc
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EXHIBIT A-V Probation Officer’s R
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EXHIBIT A-V _______________________
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SIGNATURES: EXHIBIT A-V MINOR: THIS
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FOSTER CHILD’S NEEDS AND CASE PLA
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cc: to group home, child’s(ren’
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SPECIAL INCIDENT REPORTING GUIDE FO
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4 EXHIBIT A-VIII 5. SERIOUS INJURY,
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6 EXHIBIT A-VIII 10. SIGNIFICANT IN
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SCREENING REQUIREMENT PERIODICITY S
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Anticonvulsant medications, when pr
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Dr. faxes pages 1 & 2 of PMAF to th
Page 677 and 678:
EXHIBIT A-X 2. Contact the physicia
Page 679 and 680:
EXHIBIT A-X 1. Instruct the caregiv
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APPROVAL LEVELS Section Level Appro
Page 683 and 684:
Group Home Organization: FORMAT FOR
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Exhibit A-XIIIa COUNTY OF LOS ANGEL
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Exhibit A-XIIIb COUNTY OF LOS ANGEL
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GROUP HOME PROGRAM STATEMENT EXHIBI
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TO THE HEADS OF EXECUTIVE DEPARTMEN
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implementation of individual provis
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E. Negotiation and Approval of Indi
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. The restraints or requirements im
Page 699 and 700:
objectives of the organization are
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distribution base. The result of th
Page 703 and 704:
special cost studies (such as an en
Page 705 and 706:
other activity. The bases must be e
Page 707 and 708:
g. The results of each negotiation
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49. Training costs 50. Transportati
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e. Costs identified in subparagraph
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compensation for employees on feder
Page 715 and 716:
(3) Excise taxes on accumulated fun
Page 717 and 718:
with certainty as to time, intensit
Page 719 and 720:
appeals, antitrust suits, or the pr
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(1) Donated or volunteer services m
Page 723 and 724:
(1) Capital expenditures for genera
Page 725 and 726:
(2) "Idle facilities" means complet
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enovations, alterations, equipment,
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. For non-profit organizations subj
Page 731 and 732:
already required or maintained. Als
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see paragraphs 37., Professional se
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41. Recruiting costs. a. Subject to
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continued to own the property. This
Page 739 and 740:
48. Termination costs applicable to
Page 741 and 742:
(3) Fees charges by the educational
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e. Foreign travel. Direct charges f
Page 745 and 746:
Southern Research Institute, Birmin
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A-C Handbook Page 1 AUDITOR-CONTROL
Page 749 and 750:
A-C Handbook Page 3 2.2 Cash Receip
Page 751 and 752:
A-C Handbook Page 5 If a Payroll Re
Page 753 and 754:
A-C Handbook Page 7 Outside Meals -
Page 755 and 756:
A-C Handbook Page 9 CONTRACTOR shal
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A-C Handbook Page 11 2.3 Petty Cash
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A-C Handbook Page 13 Salaried emplo
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A-C Handbook Page 15 Indirect Cost
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A-C Handbook Page 17 2.3 Acceptable
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A-C Handbook Page 19 D. UNALLOWABLE
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EXHIBIT C-II AUDITOR-CONTROLLER/DEP
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EXHIBIT C-II circumstances, the ent
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EXHIBIT C-II At the pre-exit meetin
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EXHIBIT C-II will be provided with
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CONTRACTOR EMPLOYEE ACKNOWLEDGEMENT
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Group Home Semi-Annual Expenditure
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EXHIBIT F (D) If the State Departme
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EXHIBIT F (C) Individuals who are e
Page 783 and 784:
EXHIBIT F subdivision (g). The Stat
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EXHIBIT F processing. (B) Upon requ
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EXHIBIT F self-addressed envelope f
Page 789 and 790:
EXHIBIT F shall disclose that clien
Page 791 and 792:
EXHIBIT F state, would have been pu
Page 793 and 794:
statement, fingerprints and photogr
Page 795 and 796:
Name, Address and Telephone Number
Page 797 and 798:
EXHIBIT G If a CSW or SCSW has any
Page 799 and 800:
EXHIBIT G 10) minute orders and cou
Page 801 and 802:
0500-501.20 (Rev 12/02) EXHIBIT G 4
Page 803 and 804:
EXHIBIT G See Procedural Guide 0200
Page 805 and 806:
EXHIBIT G that the research will no
Page 807 and 808:
EXHIBIT G detrimental to the safety
Page 809 and 810:
EXHIBIT G Procedural Guide 0500-504
Page 811 and 812:
EXHIBIT H of changes to the plan. (
Page 813 and 814:
EXHIBIT I (e) The child's caretaker
Page 815 and 816:
EXHIBIT I CSW in Concurrent Plannin
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Procedures A. WHEN: A CHILD IS DETA
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B. WHEN: A CHILD IS IN OUT-OF-HOME
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Dependency Investigator CSW Respons
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EXHIBIT I For offices who have impl
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EXHIBIT I FB1 Addendum, Family Back
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Department of the Treasury Internal
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DCFS GROUP HOME CONTRACT INVESTIGAT
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EXHIBIT N c) insufficient or poor f
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EXHIBIT N 5. The Division Chief or
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EXHIBIT O 1. The lesser number is a
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EXHIBIT O COUNTY OF LOS ANGELES CON
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CONTRACTOR’S CERTIFICATION OF COM
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F I F I F I F I EXHIBIT R F O R Y O
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8. Does the child receive the sport
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EXHIBIT R 33. Is the child given th
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It is best that women seek help to
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Safely Surrendered Baby Hotline (87
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Cada recién nacido merece una opor
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DATE OF ISSUE: APPLICABLE TO: LEGAL
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TA/EW b) INVALID OVERPAYMENT EXHIBI
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WHO HOW following conditions exist:
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EXHIBIT T Deposit EW 3. Reconcile t
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O/P Collection EW b) Enter the stat
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c) FAD Exception Distribution d) Ov
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s mobility and independent function
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1180.3. (a) This section shall appl
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(A) Obesity. (B) Pregnancy. (C) Agi
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PROBATION QUARTERLY REPORT FORMAT E
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Name of School: Address of School:
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Date Type Los Angeles County Probat
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Are there any SIRS to report? Yes N
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TARGET POPULATIONS WITH CORRESPONDI
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EXHIBIT Y THE TARGET POPULATION FOR
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CONTRACT NO. COUNTY PROGRAM DIRECTO
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EXHIBIT CC LOS ANGELES COUNTY SUPER
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INTRODUCTION/SUMMARY In June, 2005,
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elatives) should reflect the unique
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Additionally, every effort should b
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DEPENDENCY CASE STAGES Stage 1: Pre
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The Pre-Disposition Family Visitati
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PRELIMINARY CONSIDERATIONS/FACTORS
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• Provide a drug/weapon/violence
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• Give parents suggestions for wh
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Visitation Objectives (reason for e
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issues specific to teen parents. Th
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Circumstance Team Response in FVP
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BIBLIOGRAPHY Casey Family Programs.
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Reporting Runaways A Guide for Care
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CONTRACTOR’S OBLIGATIONS UNDER HI
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213-974-2166 EXHIBIT EE The initial
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5.0 MISCELLANEOUS EXHIBIT EE agents
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CONTRACTOR’S NAME: CONTRACT NO. C
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BACKGROUND AND RESOURCES: CALIFORNI
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It is best that women seek help to
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Safely Surrendered Baby Hotline (87
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Cada recién nacido merece una opor
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2.203.010 Findings. Chapter 2.203,
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APPENDIX M following: 1. Has ten or
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