Denial and Request for Decision Review Letter

TITLE 89: SOCIAL SERVICES CHAPTER III: DEPARTMENT OF CHILDREN AND FAMILY SERVICES PART 415 RELATIVE HOME CERTIFICATION SECTION 415.200 DENIAL AND REQUEST FOR DECISION REVIEW LETTER Section 415.200  Denial and Request for Decision Review Letter If certification, initial placement, or visitation is denied, and after the caregiver applicant has been offered the opportunity to correct any deficiencies, a template letter shall be completed explaining the reasons for the denial and offering the opportunity to request a Department Decision Review. Only a Department- Issued official form with a CFS number in the top left-hand corner shall satisfy the requirements of this Part. The form shall consist of the following elements: a)         Date. b)         Applicant's name. c)         Applicant's address. d)         Children's names. e)         The reasons certification, initial placement, or visitation is not being recommended. f)         Name of the representative. g)         Job title of the representative. h)         Email address of the representative. i)          Phone number of the representative. j)          Instructions for how to request a decision review, which contain the following text: "First, take a moment to gather your thoughts and start thinking about what issue needs to be resolved, how you think it should be resolved, and what outcome it is you are looking for. You can request a Department Decision Review for reasons such as: Child abuse, neglect or another crime was found on your criminal record. Your home did not meet our standards for certification. The child's needs cannot be met by your family at this time. The child was placed with you. You have been denied visitation with the youth in care. To request a Department Decision Review, please complete and submit the form included with this letter within 30 days of the date of this letter. The Department, within ten business days after the receipt of the request, will hold a decision review. A final decision will be made by the Department within ten business days after the review is held. If the child is currently placed with you and a change in placement is recommended, you will receive a separate statement on the right to appeal the change at that time." k) A Decision Review Form the relative can return if they wish to request a decision review which contains the following elements: 1)         Instructions for how to request a decision review, which contain the following text: "First, check the box below and sign and date if you wish to request a Department Decision Review." 2)         Checkboxes for each of the following: A)        I wish to request a Certification Decision Review regarding my denial of relative home certification. B)        I wish to request a Placement Decision Review regarding my denial of initial placement of a youth in care in my home. C)        I wish to request a Visitation Decision Review regarding my denial of visitation with a youth in care. 3)         A place for the relative's signature and date. 4)         Instructions for where to send the form to, including the following text: "Second, make a copy of the form for your records and send to (email or postal address)". 5)         A place for an email or postal address where the completed form must be sent. 6)         Instructions to attach any additional information, including the following text: "If you wish to submit additional information to support your case, please attach it to the email or include it in the envelope with this form. This additional information will be submitted to the review panel and included in the review."