Table of Contents
Chapter 18- Licensing of Child Placing Agencies
- 18.01 Initial Licensing Process Effective 8/1/22
- 18.02 Initial Site Review Effective 8/1/22
- 18.04 Licensing Denials Effective 8/1/22
- 18.05 License Revocations Effective 1/1/23
- 18.06 Referral Holds Effective 8/1/22
- 18.12 Rate Setting Effective 11/1/22
Tools
- LCPA Site Review Tool - Available from the RLU
- Indiana Transparency Portal
- Vendor Profile Attachment Guide
Forms
- Application for License to Operate a Child Placing Agency (LCPA) (SF47106)
- Automated Direct Deposit Authorization Agreement (SF47551)
- Background Check Review Form - Available from the RLU
- Background Check Review Summary - Available from the RLU
- Contract Request Form - Available from the Contract Specialist Supervisor
- Cost Report - Available from the RLU
- Information Systems Access and Use Agreement KidTraks User Agreement (SF56798)
- LCPA Initial Licensure Application Review Checklist - Available from the RLU
- LCPA New Agency Training Evaluation Form - Available from the RLU
- LCPA Staffing Form - Available upon request from the RLU
- Licensed Child Placing Agency (LCPA) Licensing Inquiry (SF57094)
- Notice of Approved Rate and Right to Administrative Review Letter - Available from the RLU
- Request for Administrative Appeal Hearing Residential Treatment Services Provider "RTSP"/Child Placing Agency "CPA" Rates (SF55062)
- Request for Administrative Hearing - Residential License Denial or Revocation (SF57115)
- Residential Treatment Services Provider (RTSP) and Child Placing Agency (CPA) Rates Administrative Review Request (SF 55061)
- W-9 and Direct Deposit Form Instructions
- W-9 and Direct Deposit Form Q & A
- W-9 Request for Taxpayer Identification Number and Certification