CHINS Benchbook Forms

The following forms comply with provisions of HEA 1001, which requires that court orders include "language approved and recommended by the judicial conference of Indiana in relation to removal or detention." Failure to adopt language from these forms, most significantly the federal IV-E language, may result in your county being liable for the costs of placement of a child.

The forms below are available in Microsoft Word format. To view and print Word documents, you must have Microsoft Word installed on your computer.

Forms last updated or newly approved: August 25, 2017

Department of Child Services Reports

Form # Form Title Date Approved Date Revised
PI-R2 Intake Officer's Report of Preliminary Inquiry and Investigation 10.01.08 10.01.08
IA-R3 Program of Informal Adjustment 10.01.08 01.01.11
PDR-R2 Predispositional Report 10.01.08 10.01.08
ProgRpt-R2 Progress Report - Final 10.01.08 10.01.08
ModRpt-R2 Modification Report 10.01.08 10.01.08
PermRpt-R2 Progress Report - Permanency 10.01.08 10.01.08

Chapter 3. Intake

Form # Form Title Date Approved Date Revised
C-3.02 Intake Information for Child in Need of Services
Indiana Code 31-34-7-1		 12.08.08 12.08.08
C-3.03 Preliminary Inquiry Appointment 12.08.08 12.08.08
C-3.04 Consent to Background Investigation and Release 12.08.08 12.08.08
C-3.05 Advisement of Legal Rights Upon Taking Custody of / Filing a Petition on Behalf of a Child Alleged to be a Child in Need of Services 12.08.08 03.01.10

Chapter 4. Informal Adjustment

Form # Form Title Date Approved Date Revised
C-4.02 Request for Approval of Program of Informal Adjustment 12.08.08 12.08.08
C-4.03 Order of Denial of Program of Informal Adjustment 12.08.08 12.08.08
C-4.04 Order of Approval and Participation in Program of Informal Adjustment 12.08.08 12.08.08
C-4.05 Motion for Extension of Program of Informal Adjustment 12.08.08 12.08.08
C-4.06 Order to Extend Program of Informal Adjustment 12.08.08 12.08.08
C-4.07 Progress Report on Program of Informal Adjustment 12.08.08 12.08.08

Chapter 5. Detention and Custody

Form # Form Title Date Approved Date Revised
C-5.03 Emergency Custody Order 12.08.08 02.03.10
C-5.04 Written Promise for Appearance of Child 12.08.08 12.08.08
C-5.05 Notice of Detention of Child 12.08.08 12.08.08
C-5.06 Notice of Detention Hearing 12.08.08 12.08.08

Chapter 6. Filing CHINS Petition

Form # Form Title Date Approved Date Revised
C-6.02 Request for Filing of Petition 12.08.08 12.08.08
C-6.03 Order Authorizing Filing of CHINS Petition 12.08.08 12.08.08
C-6.04 Verified Petition Alleging Child in Need of Services 12.08.08 12.08.08
C-6.05 Order Authoring Taking Child into Custody 12.08.08 12.08.08
C-6.06 Order Setting Initial Hearing on Petition and for Issuance of Summons 12.08.08 12.08.08
C-6.07 Summons 12.08.08 12.08.08
C-6.08 Summons 12.08.08 12.08.08
C-6.09 Motion for Exclusion of Child 12.08.08 12.08.08

Chapter 7. Initial Hearing

Form # Form Title Date Approved Date Revised
C-7.02 Dialogue for Detention/Initial Hearing CHINS 12.08.08 09.28.15
C-7.03 Order on Initial/Detention Hearing 12.08.08 02.03.10
C-7.04 Supplemental Order on Consideration of Placement Program, or Services
Admissions of CHINS		 12.08.08 02.03.10
C-7.05 Financial Obligation Order 12.08.08 10.01.09
C-7.06 Petition for Additional Detention Hearing 12.08.08 10.01.09
C-7.07 Order of Appointment of CASA 12.08.08 10.01.09

Chapter 8. Fact Finding

Form # Form Title Date Approved Date Revised
C-8.02 Order on Fact-Finding Hearing on CHINS Petition
Order Finding Child is a Child in Need of Services		 12.08.08 02.03.10
C-8.03 Order on Fact-Finding Hearing on CHINS Petition
Order Finding Child is Not a Child in Need of Services		 12.08.08 12.08.08

Chapter 10. Disposition

Form # Form Title Date Approved Date Revised
C-10.02 Dialogue for Dispositional Hearing 12.08.08 10.01.09
C-10.03 Dispositional Order 12.08.08 02.03.10
C-10.04 Order to Reconsider 12.08.08 02.03.10
C-10.05 Dispositional Reconsideration Order 12.08.08 02.03.10
C-10.06 Financial Obligation Order 12.08.08 12.08.08
C-10.07 Finding and Order 12.08.08 02.03.10

Chapter 11. Court Orders to Parents

Form # Form Title Date Approved Date Revised
C-11.02 Petition for Parental Participation 12.08.08 12.08.08
C-11.03 Order of Participation 12.08.08 12.08.08

Chapter 13. Modification & Permanency

Form # Form Title Date Approved Date Revised
C-13.02 Motion to Modify Dispositional Decree 12.08.08 12.08.08
C-13.03 Order for Hearing on Motion to Modify
Including Temporary Emergency Order		 12.08.08 12.08.08
C-13.04 Notice of Hearing 12.08.08 12.08.08
C-13.05 Order Granting Modification 12.08.08 02.03.10
C-13.06 Supplemental Order 12.08.08 02.03.10
C-13.07 Order on Periodic Case Review 12.08.08 12.08.08
C-13.07a Order on Periodic Review Hearing - APPLA 04.29.15  
C-13.08a Order Approving Permanency Plan - Non-APPLA 04.29.15  
C-13.08b Order Approving Permanency Plan - APPLA 04.29.15  
C-13.09 Judgment for Reimbursement 12.08.08 12.08.08

Chapter 14. Miscellaneous

Form # Form Title Date Approved Date Revised
C-14.01 Dual Status Screening Tool Report 03.10.16  
C-14.02 Referral to Dual Status Assessment Team 03.10.16  
C.14.03 Recommendation of Dual Status Assessment Team 03.10.16  
C.14.04 Order on Recommendation of Dual Status Assessment Team 03.10.16  
C.14.05 Emancipation Order 03.10.16  
C.14.06 Expungement Form 08.25.17  
C.14.07 Expungement Order 08.25.17  

Chapter 15. Indian Child Welfare Act

Form # Form Title Date Approved Date Revised
C-15.01 Indian Child Welfare Act Benchcard 05.01.17  
C-15.02 Initial Hearing Order 05.01.17