ICPC Referral Checklist .us



ICPC Referral Checklist

For all requests:

• Form 100A* (one per child)

• Cover letter (form 100E* or similar, one per sibling group going to same resource)

• Form 1044* (one per child, completed by your IV-E specialist)

• Form 161* (one per sibling group going to same resource)

• Copy of most recent court order showing Oregon DHS has custody of the child

• Copy of most recent case plans (Ongoing and Child Specific)

• Copy of recent evaluations or other documentation regarding any special needs the child may have

• If available, copy of birth certificate

• If available, copy of Social Security card

For adoption requests:

All of above, plus:

• Copy of TPR orders or relinquishments, if child is legally free

• Copy of adoption child summary, if completed

• If applicable, copy of family’s home study for general applicant family selected at committee

***E-mail request to oregon.icpc@dhsoha.state.or.us ***

Do not save the referral packet into OR-Kids because much of it duplicates information already there.

The ICPC unit will create the ICPC record in OR-Kids, which you can view to confirm when the request is sent out to the other state.

Case assignments are based on the oldest child’s last name:

We file under oldest child's last name:

A – E  Patty McCartney, 971-707-1805, patricia.s.mccartney@dhsoha.state.or.us

F – K  Marcy Stenerson, 971-707-1813, marcy.m.stenerson@dhsoha.state.or.us

L – Q  Lillie Axen, 971-707-1849, lillian.e.axen@dhsoha.state.or.us

R – Z  Margie Salazar/ Amanda Kramer, 971-707-1990/971-707-1975, margarita.s.salazar@dhsoha.state.or.us; amanda.m.kramer@dhsoha.state.or.us

New requests: Jamie Davis, 971-790-0699, Jamie.l.davis@dhsoha.state.or.us Please send new referrals to Oregon.icpc@dhsoha.state.or.us

* Form available on-line

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