Conversion of Intrastate Placements – An ICPC request must be initiated prior to

Conversion of Intrastate Placements – An ICPC request must be initiated prior to an intrastate placement becoming interstate due to a child relocating with an approved foster family. A referring MDCPS employee must include the following documents in the referral packet: 1. A completed ICPC-100A, which must contain the family’s new address; 2. An ICPC referral checklist; 3. A cover letter on Agency letterhead; 4. A family functional assessment or current social history of the child; 5. A family permanency plan; 6. A case history; 7. A current custody order and other pertinent court documents; a. The custody order must be signed and dated within a year of the request packet’s submission. b. Other pertinent court documents include petitions and previous custody orders. 8. An ICPC medical/financial plan and supporting documents; 9. A copy of the child’s IEP, if applicable; 10. A copy of the child’s Social Security card and birth certificate; 11. Copies of the family’s most recent judicial review court report and court order; 12. Copies of any progress reports on the family for the past six (6) months; 13. A copy of the family’s foster care license, which must be dated within two years of the referral packet’s submission; 14. An explanation of the child’s IV-E eligibility and IV-E documentation, if available; 15. MDCPS Pre-screening Form Reg-2; 16. A valid foster home study/reassessment, which must include the criminal history and fingerprinting results of all applicable family members; and 17. An ICPC 100-B, if the child is already in the Receiving State, which must contain the family’s new address and the date they relocated. The original referral packet and two (2) copies may be mailed to the ICPC Unit or a complete referral packet may be scanned and emailed to the ICPC Unit. Upon the filing of an ICPC referral packet described above, the child may move with the approved Mississippi foster family prior to the issuance of a placement decision by the Receiving State ICPC Office. The Mississippi foster home must meet foster home approval and/or licensure requirements in the Receiving State to maintain placement of the child.