Skip to main content
Search
Search
Language Support
English
ያግኙን - Amharic
العربية - Arabic
中文 - Chinese (Simplified)
繁體中文 - Chinese (Traditional)
دری - Dari
فارسی, fārsī - Farsi
Français - French
हिंदी - Hindi
ភាសាខ្មែរ - Khmer
한국어 - Korean
ਪੰਜਾਬੀ - Punjabi
Pусский - Russian
Af Soomaali - Somali
Español - Spanish
Kiswahili - Swahili
Tagalog - Tagalog
Українська - Ukrainian
Tiếng Việt - Vietnamese
Safety
Report Child Abuse
Child Abuse and Neglect Founded Findings
Child Abuse Prevention Tips
Safety and Well-Being of Infants
Youth Suicide Prevention
Safe Sleep & Other Safety Tips
Victims of Crime
Services
For Families
Child Care / Early Learning
Child Development Supports
Child Welfare System
Foster Parenting & Kinship Care
Adoption
Adoption Support
Engaging Fathers
Housing and Basic Needs
For Youth
At-Risk / Runaway Youth
Foster Youth Services
Housing and Homelessness Prevention
Juvenile Rehabilitation
Youth and Young Adult Housing Response Team
For Providers
Child Care / Early Learning Providers
Child Welfare Providers
Child Development Support Providers
Child Care & Early Learning Professional Development
Child Placing Agencies
Group Care
MERIT
Mandatory Reporting of Child Abuse or Neglect
Social Service Payment System (SSPS)
Our Practice
Practice Improvement
Forms & Publications
Strategic and Racial Equity Plan
Office of Innovation, Alignment, and Accountability
Policy, Laws and Rules
Racial Equity and Social Justice
Reports
Tribal Relations
Tribal Relations Intro
Government-to-Government Relations
Indian Child Welfare
Tribal Foster Care
Tribal Early Learning
Juvenile Rehabilitation
Training
About
About Us
Our Leadership
Vision and Mission
Jobs
Government Affairs
Community Engagement
Media & News
Agency Performance
Family Separation Rapid Response Team
Maternity Services Checklist
Form Number
16-184
Revision Date
01-2019
Form File
English (Word)
