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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