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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: February 28, 2020
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 (Short) | 12.08.08 | 02.28.20 |
| 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-7.03 | 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-10.03 | 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 | |
| C.14.08 | Foster Parent Reporting Form | 01.30.20 | |
| C.14.09 | Notice of Exclusion for Jurisdiction Notice & Case Closure | 10.23.20 | |
| C.14.10 | Notice of CHINS Jurisdiction | 02.28.20 | |
| C.14.11 | Notice of Case Closure | 02.28.20 |
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 |