Adoption subsidy review (AA)

Form/Request Date Received

Enter the date the JFS review form or the date of the agency's or family's request for a modification to the subsidy agreement. Use the format MM/DD/YYYY.

Termination Mailed Date

Enter the date the agency sent a letter to the family indicating that the subsidy agreement was terminated. Use the format MM/DD/YYYY.

State Hearing Requested Date

If the family is requesting a hearing with the State, enter the date the family made this request. Use the format MM/DD/YYYY.

Adoptive Parents Still Supporting Child

If the family is requesting that the subsidy be continued, select this check box if this statement applies to the family.

Adoptive Parents Still Legally Responsible for Child

If the family is requesting that the subsidy be continued, select this check box if this statement applies to the family.

Annual Family Gross Income

If the family is requesting the subsidy be continued, enter the family's income.

Family Size Including Adopted Child(ren)

If the family is requesting that the subsidy be continued, enter the total number of children in the home.

Action

If the subsidy agreement is being modified, suspended, or terminated, select the type of action being taken.

Action Reason

If the subsidy agreement is being modified, suspended, or terminated, select the reason for the action.

Action Date

Enter the date the action was taken. Use the format MM/DD/YYYY.

Requested Amount

If the agency or family is requesting a change to the amount of the subsidy, enter the amount requested.

Modified Amount

If the agency or family is requesting a change to the amount of the subsidy, enter the new amount of the subsidy.