Voluntary relinquishment of parental rights form california

Relinquishment Procedures and the Statement of Understanding

0200-508.10 | Revision Date: 07/01/14

Overview

This policy guide outlines how to complete and accept a relinquishment document and a Statement of Understanding for parents who read English and for parents who cannot read English or any other language. It details how to provide services to parents who are considering relinquishing a child for adoption and how to notify all required parties of a relinquishment.

TABLE OF CONTENTS

Policy

Relinquishment of a Child

Parents with Children Voluntarily Removed

Out-of-State Relinquishment

Advisement

Relinquishment Document

Notice of a Dependent Child's Relinquishment

Procedure

Ensuring Relinquishment Requirements are Met

APRD CSW Responsibilities

Providing Services to Parents Considering Relinquishment

ARPD CSW Responsibilities

Advising a Birth Mother and Presumed Father Parent

APRD CSW Responsibilities

Advising an Alleged Natural Father of a Child who is not Detained or a Court Dependent

ARPD CSW Responsibilities

Advising a Parent whose Child has been Removed

ARPD CSW Responsibilities

Completing the Statement of Understanding

APRD CSW Responsibilities

Discussing Filing Options and Time Frames

APRD CSW Responsibilities

Accepting the Relinquishment Document

APRD CSW Responsibilities

Selecting the Appropriate Relinquishment Document

APRD CSW Responsibilities

Determining if the Relinquishment Document can be Signed

APRD CSW Responsibilities

Notifying the Court of a Dependent Parent's Relinquishment

APRD CSW or DI Responsibilities

SCSW Responsibilities

Assisting a Parent who cannot Read Relinquishment Documents

APRD CSW Responsibilities

Approvals

Helpful Links

Attachments

Forms

Referenced Policy Guides

Statutes

Version Summary

This policy guide was updated from the 06/28/10 version, as part of the Policy Redesign, in accordance with the DCFS Strategic Plan. This policy guide incorporates content from Procedural Guide 0200-508.14, Accepting the Statement of Understanding & Relinquishment Documents, 0200-508.20, Relinquishment and Consent Procedures for Parents Who Cannot Read English and/or Any Other Language, and 0300-503.19, Notifying the Court of a Parent's Relinquishment, thereby cancelling those policy guides. The title of this policy guide has been changed from Advising and Providing Services to Parents Prior to Accepting a Statement of Understanding and Relinquishment Document.

POLICY

Relinquishment of a Child

Relinquishment is a permanency option that is offered as part of the full disclosure process throughout a child's case. It is a permanent decision and must be made by the child's parent(s) voluntarily and without coercion from any entity.

A relinquishment is completed by an Adoption and Permanency Resources Division (APRD) CSW. When a parent indicates an interest in relinquishing his/her child for adoption, the parent is referred to the Resource Family Recruitment Line (888) 811-1121 and must select option 2 to speak to an APRD representative.

On a case-by-case basis, a designated relinquishment can be accepted before the designated person(s) is approved to adopt as long as the birth parent understands the child can be placed only if the designated person's application to adopt has been approved. In such a case, the birth parent is notified and has the opportunity to rescind the relinquishment and either designate another person or request the child be returned to him/her.

If a petition has been filed to terminate the parental rights of an alleged father and the adoptive placement has been approved by the ARA, the placement can proceed. The adoptive placement can also proceed if an identified father signs one (1) of the following forms:

• AD 588, Denial of Paternity by Alleged Natural Father (In or Out of California)

• AD 590, Waiver of Right to Further Notice of Adoption Planning (Alleged Natural Father In- or Out-if California)

• AD 590A, Waiver of Right to Further Notice of Adoption Planning (Presumed Father In- or Out-of-California)

The court may dispense with a hearing and issue an Ex Parte Application and Order to terminate parental rights if any of the following apply:

• The identity or whereabouts of the alleged father are unknown.

• The alleged father has been served with a written notice of his alleged paternity and the potential adoption, and he has failed to respond.

• The alleged father has signed a waiver of his right to notice or a denial of paternity.

Upon assignment of a relinquishment case, the APRD CSW must have a minimum of two (2) face-to-face interviews with the parent(s) over a period of two (2) or more days.

• If the child to be relinquished has not yet been born, at least one (1) interview must occur after the child is born.

• A sample copy of the Statement of Understanding and the relinquishment documents are provided to the birth parent(s) during the first interview for his/her review.

• If appropriate, the APRD CSW accepts the relinquishment upon completing the second interview with the parent(s).

Parents with Children Voluntarily Removed

Parents whose child has not been involuntarily removed from their care include:

• Parents of children who are voluntarily placed in out-of-home care with agencies such as DCFS or the Regional Center.

• Parents who are receiving Family Maintenance (FM) services for children who are court dependents but remain in the parent's care.

Out-of-State Relinquishment

• By law, if a relinquishing parent and a non-court dependent child reside outside of California, and if the child is to be cared for and placed for adoption by DCFS, the parent may relinquish the child to DCFS after the following requirements are met:

• Before signing the relinquishment, the parent received the same counseling and advising services from DCFS that he/she would from an agency that is licensed or approved to provide adoption services in the state of the parent's residence.

• The relinquishment form is signed by DCFS before being signed by the parent.

• This signifies DCFS's willingness to accept the relinquishment.

• The relinquishment form is then signed by the parent in the presence of an APRD CSW.

Advisement

Parents that have had their child removed from their care must be advised on the relinquishment process.  This ensures that the relinquishment document is signed voluntarily and that the parents understand the availability of child welfare and legal services and the significance and the finality of relinquishing a child.

A parent who relinquishes a child must clearly understand that the court decides whether family reunification (FR) services are to be ordered. If a parent is uncertain of his/her eligibility for FR services and if these services affect his/her decision to relinquish a child, the parent should seek this information from the APRD CSW or the parent's attorney prior to signing the relinquishment document.

Relinquishment Document

The relinquishment document cannot be altered or corrected unless the correction or alteration is initiated by the following individuals:

• Parent who signed the document

• Reader or translator, if applicable

• A DCFS employee who translates and/or reads the relinquishment document is not responsible for providing adoption services to the relinquishing or consenting parent(s) or to the prospective adoptive parent(s).

• The translator and reader may be required to testify in court.

• Authorized agency representative

• Witnesses to the relinquishment

Back to Policy

Notice of a Dependent Child's Relinquishment

If a parent has relinquished to DCFS or to a licensed adoption agency for the purpose of adoption a child who has been found to be a dependent of the juvenile court, DCFS/the agency must provide written notice of the relinquishment within five (5) court days to all of the following:

• Juvenile court having jurisdiction of the child.

• Child's attorney, if any.

• Relinquishing parent's attorney, if any.

Back to Policy

PROCEDURE

Ensuring Relinquishment Requirements are Met

APRD CSW Responsibilities

1. Determine if the following conditions are met and documented in Case Notes:

• That the relinquishing parent resides in Los Angeles County or that the child is a dependent of the court in this county

• That the parent has chosen the plan of adoption for the child and freely chosen to relinquish the child

• Whether the child is subject to the provisions of the Indian Child Welfare Act (ICWA)

• That DCFS is able to place the child for adoption and that the parent is willing to sign the SOC 155, Voluntary Placement Agreement--Placement Request, for DCFS to provide temporary out-of-home care of the child, if the child is not a dependent of the Los Angeles County court

• That the parent has received needed services and advisement, as appropriate

• That the parent has the ability to understand the content, nature, and effect of signing the relinquishment document

1. Based on the determination, take the appropriate action:

1. Contact the Placement and Recruitment Unit (PRU) to determine if there is an available home.

1. If there is not an available home:

1. Do not accept the relinquishment document.

1. Discuss voluntary placement with the parent.

1. If the parent has designated whom he/she wants to adopt the child:

1. Advise the parent that the child cannot be placed with the designated family until it is determined that a designee will be approved for adoptive placement and/or meets the requirements for a foster care placement.

1. Discuss voluntary placement with the parent until a foster or adoptive placement can be made.

1. If appropriate, obtain the parent's signature on the SOC 155 for DCFS to provide temporary out-of-home care for the child.

1. If there is reason to suspect that the parent does not understand the content, nature, and effect of signing the relinquishment document:

1. Refer him/her to a licensed physician or licensed clinical psychologist for an evaluation prior to accepting the parent's signature.

• An evaluation is always required if either the parent is receiving SSI/SSP for a mental illness or a developmental disability or if the parent has received psychiatric treatment within the past two (2) years.

1. Complete the AD 100A, Authorization for Use and/or Disclosure of Health Information Agency Adoption Program.

1. Obtain the parent's signature to authorize the release of the evaluation to DCFS.

1. If the parent needs a translator, refer to Assisting a Parent who Cannot Read Relinquishment Documents.

1. Explain the purpose of DCFS in the relinquishment process and the relevant services that it provides.

1. During the first interview with the parent, provide him/her with copies of the appropriate Statement of Understanding and the relinquishment document.

Back to Procedure

Providing Services to Parents Considering Relinquishment

APRD CSW Responsibilities

During the required face-to-face interviews:

1. Provide the DCFS/A 14, Parent's Request for Service, to the parent to complete and sign.

1. Explain the purpose of DCFS in the relinquishment process and the relevant services that are provided.

1. Provide the parent with counseling to, at a minimum, assist him/her in:

• Understanding the long-range implications of relinquishing his/her child to DCFS for adoption

• Discerning his/her feelings regarding the relinquishment

• Freely making his/her choice to relinquish the child for adoption

• If the parent decides to relinquish the child, assisting him/her in deciding:

• Whether to complete a standard or a designated relinquishment

• If appropriate, whether he/she wishes to complete a Postadoption Contact Agreement and, if so, the conditions that would be included

1. Inform the parent that, prior to accepting the relinquishment document; DCFS must determine that it is able to place the child for adoption.

1. Inform the parent that if DCFS believes it may be difficult to do so, the Placement and Recruitment Unit (PRU) is contacted to decide if there is an available home.

• If there is a not an adoptive home available, DCFS will not accept the relinquishment document until one is found.

1. Inform the parent that he/she must be willing to sign a voluntary placement agreement with DCFS if both:

• DCFS determines it not difficult to place the child for adoption.

• The parent wishes to place the child in foster care either while considering relinquishment or before signing the relinquishment document.

1. If a parent is ready to place the child, provide the parent with the SOC 155, Voluntary Placement Agreement -Placement Request, and assist him/her, as needed, in completing it.

1. Ensure that the request includes a statement that the parent is considering relinquishment.

1. If the placement is being requested on behalf of an Indian child, have the parent complete the SOC 155C, Voluntary Placement Agreement Parent/Agency (Indian Child).

1. Obtain the parent's signature on the original SOC 155 or SOC 155C and on one (1) copy. Sign and date the form.

1. Provide the parent with a copy and file the original in the case record.

1. Review the terms of the voluntary placement agreement (SOC 155 or SOC 155C) with the parent.

• If the birth mother has not signed the relinquishment within thirty (30) days of the child being placed, develop a Case Plan and follow the procedures outlined in Voluntary Placement.

1. Explain that a WIC 300 petition will be filed after five (5) months of voluntary placement in the following circumstances:

• The parent has not requested the return of the child.

• One (1) or both birth parents have not followed through with voluntarily relinquishing the child.

• The child has been voluntarily relinquished but not adoptively placed.

• The child has been freed for adoption by one (1) or both parents for twelve (12) months through:

• Relinquishment

• The termination of parental rights

• A granted adoption petition

1. If after five (5) months of voluntary placement, the child has not been adoptively placed, file a WIC 300 petition within six (6) months of the SOC 155 or the SOC 155C being signed by the parent(s). This does not apply when all of the following are met:

• A birth mother has signed the relinquishment.

• An acknowledgement of the relinquishment was issued.

• The child was adoptively placed prior to the end of the six (6) month period.

• There is a legal action pending for the alleged father.

1. If the child is in a health care facility:

1. Obtain the completed AD 22, Health Facility Minor Release Report, signed by the parent from the health care facility before accepting the child for placement.

1. Complete Section III of the AD 22, and sign and date the form.

1. Return the signed form to the facility, and keep one (1) copy for the case record.

1. If the parent has designated whom he/she wants to adopt the child, do not accept the relinquishment document or voluntary placement agreement until it is determined that the designated family will be approved for the adoptive placement.

1. Provide the relinquishing parent(s) a sample copy of the relinquishment document and a Statement of Understanding for his/her review.

1. Have the birth parent(s) complete the AD 67, Information about the Birth Mother, and the AD 67A, Information about the Birth Father, to obtain medical and social background information from the birth parent(s). If needed:

1. Assist the parents in completing the forms.

1. If one parent is not interviewed, assist the present parent in completing the other's form.

1. If needed, suggest that parent(s) consult family members when completing the form(s), and assist them in contacting the family members.

1. Obtain the parent's authorization on the AD 100A, Authorization for Use and/or Disclosure of Heath Information Agency Adoption Program, to acquire the following information, as appropriate:

• Verification of the birth mother's marital history

• Reports pertaining to the birth parent's medical background, including illness, disease, or defects of a hereditary or genetic nature

1. Obtain the medical history of the birth parent's extended family.

• Reports regarding the birth mother from the prenatal physician and from the physician who delivered the child or the hospital in which the child was born, including any medications taken or any complications

• Reports or evaluations regarding the birth parent from medical or mental health professions, hospitals, or institutions in which the birth parent has received in-patient or out-patient services

• Any documentation or oral reports that indicate the birth parent may be of American Indian ancestry

1. Inform the parent of an Indian child that there must be an order of placement preference for the child in either voluntary or dependency relinquishment cases.

1. Refer to Adopting and Serving Children Under the Indian Child Welfare Act (ICWA).

1. Obtain documentation from the relinquishing parent(s) that verifies the identity of the child's mother, any presumed fathers, and any alleged natural fathers.

1. Photocopy all available documents for the case record.

1. Explain the important, possible repercussions of not accurately identifying other possible parents.

1. Provide the AD 880, Declaration of Mother, to the birth mother for documentation of her response to the following questions.

• Does a judgment of paternity already exist?

• Was the mother married at the time of the child's conception or at any time thereafter?

• Was the mother cohabitating with a man at the time of the child's conception or the birth of the child?

• Has the mother received support payments or promises of support pertaining to the child or in connection with her pregnancy?

• Has any man formally or informally acknowledged or declared his possible paternity of the child?

• If paternity tests have been administered, what are the results?

1. Have the birth mother sign and date the form once it is complete.

• If mother is not available, obtain the information from an appropriate person.

1. Report the results of the AD 880 questions to the court in the final adoption report and in any other report that concerns the termination of parental rights for the presumed or alleged father.

1. If the relinquishing parent does not reside in California, provide the above services by telephone and/or with the assistance of an adoption agency in the state or country where the parent is to the extent possible.

Back to Procedure

Advising Birth Mother and Presumed Father

APRD CSW Responsibilities

Take the following actions when advising a mother or a presumed father who is considering relinquishing a child who has been voluntarily removed:

1. If the child is not a dependent of the court, inform the birth parent(s) of his/her rights to seek legal counsel to assist in the relinquishment process.

• Upon a parent's request, refer him/her to legal resources, such as attorney referral services, legal aid offices, or other known public legal assistance services.

1. If the child is a juvenile court dependent, inform the parents of his/her right to seek legal counsel from the attorney representing him/her in the dependency case.

1. If interviewing a presumed father, explain the reason that DCFS believes him to be the child's presumed father and, if necessary, the definition of a "presumed father".

1. Explain the following information to the parent(s), as applicable:

Back to Procedure

Advising an Alleged Natural Father of a Child who is not Detained or a Court Dependent

ARPD CSW Responsibilities

1. Explain the following to the alleged natural father of a non-detained or non-court dependent child:

• The reasons DCFS considers himself to be the alleged natural father of the child

• The alleged natural father's right to:

• File a petition with the court to establish paternity, if he wishes to take paternal responsibility for the child

• Deny paternity

• Waive his right to further notice of the adoption proceeding

• Sign a relinquishment

• Take no action

• Seek legal counsel regarding his choices or decision, for assistance in contesting an adoption, or to appeal DCFS's petition to terminate his parental rights

• DCFS' plan for the child

• The extent that DCFS will allow the alleged natural father to participate in the selection of the adoptive family, if he decides to sign a relinquishment

• The alternatives to adoptive placement

1. Determine what actions the alleged natural father wishes to take.

1. Upon his request and as appropriate, refer him to attorney referral services, legal aid offices, or other, known public legal assistance services.

1. Provide him with the appropriate Statement of Understanding to complete.

1. Review the Statement of Understanding with the birth parent to ensure that he/she understands the meaning of each item and to answer any questions.

Back to Procedure

Advising a Parent whose Child has been Removed

ARPD CSW Responsibilities

When advising a mother or a presumed father who is considering relinquishing a child who is detained, a juvenile court dependent in out-of-home care, or a ward of a legal guardian, take the following actions.

1. Inform the parent of his/her right to seek legal counsel from the attorney representing him/her in the dependency case.

1. Encourage each parent to discuss the decision to relinquish the child with his/her attorney.

1. Inform the parent that DCFS must follow the legal noticing requirements, which require DCFS to provide written notice of the relinquishment within five (5) court days to the following parties:

• Juvenile court having jurisdiction of the child

• Child's attorney

• Relinquishing parent's attorney, if applicable

1. If the child is the subject of a legal guardianship established by the Probate Court, refer the parent to attorney referral services, legal aid offices, or other known public legal assistance services.

1. Explain the following to the mother or the presumed father:

• DCFS' reason for believing he is the child's presumed father

• That if a presumed father does not believe himself to be the child's father but agrees to adoption, he may either:

• Sign a relinquishment document, stating that though he is relinquishing his parental rights, he does not believe that he is the child's father

• File a petition with the court asking it to determine that he is not the child's father.

• DCFS' adoption plan for the child

• The extent that DCFS will allow the alleged natural father to participate in the selection of the adoptive family, if he decides to sign a relinquishment

• The services available, as determined by the child's juvenile court status, to assist him/her in obtaining resources and skills needed to parent the child

• Alternative forms of adoption

• That the juvenile court can terminate parental rights if it determines reunification is not possible

• That he/she has the right to seek legal counsel from his/her attorney in a dependency case to contest and appeal the court's action

1. Refer the parent to the case-carrying CSW if he/she wants more information regarding available services either before deciding whether to relinquish the child or if he does not want to relinquish the child.

1. If the child is the subject of a legal guardianship established by the Juvenile Court or the Probate Court, refer to Change of Permanent Plan from Legal Guardianship to Adoption.

1. Provide each parent with the appropriate Statement of Understanding to complete.

1. Review the Statement of Understanding with the birth parent to ensure that he/she understands the meaning of each item and answer any questions.

1. Follow all additional steps outlined sin Advising an Alleged Natural Father of a Child who is not Detained or a Court Dependent.

Back to Procedure

APRD CSW Responsibilities

1. For Indian children, adhere to the procedure outlined in Adopting and Serving Children Under the Indian Child Welfare Act (ICWA).

1. Provide each birth parent with the appropriate Statement of Understanding to complete.

1. Choose one (1) of the following forms, as appropriate, for a child who does not fall under the ICWA:

• AD 885, Statement of Understanding Agency Adoption Programs – A Mother or a Presumed Father of a Child Who is Not Detained, a Juvenile Court Dependent in Out-of-Home Care, or the Ward of a Legal Guardian

• AD 885A, Statement of Understanding Agency Adoption Programs – A Mother or a Presumed Father of a Child Who is Detained, a Juvenile Court Dependent in Out-of-Home Care, or the Ward of a Legal Guardian

• AD 885C, Statement of Understanding Agency Adoptions Program – Alleged Natural Father of a Child Who is Not Detained, a Juvenile Court Dependent in Out-of-Home Care, or the Ward of a Legal Guardian

• AD 885D, Statement of Understanding Agency Adoptions Program – Alleged Natural Father of a Child Who is Detained, a Juvenile Court Dependent in Out-of-Home Care, or the Ward of a Legal Guardian

1. Ensure that the appropriate Statement of Understanding is signed prior to the relinquishment document being accepted.

1. Review the Statement of Understanding with the parent to ensure that he/she understands the relinquishment process, is signing the form of his/her own free will, and understands the finality of the adoption.

1. If the parent understands this and wishes to proceed:

1. Indicate his/her understanding by initialing each explanatory statement.

1. Indicate his/her preference regarding options for the filing of the relinquishment document by checking the box next to his/her choice.

1. If the parent does not have a clear understanding of the information in the Statement of Understanding, do not proceed until the parent's questions are clarified.

1. If it is determined that the parent who is signing the relinquishment does not read English and/or another language, adhere to the procedures outlined in Assisting a Parent who Cannot Read Relinquishment Documents.

1. Obtain the parent's signature on the original and three (3) copies of the Statement of Understanding. The Statement of Understanding must have original signatures.

• If the parent-child relationship status is the same for all children being relinquished, the parent can sign one (1) copy for the relinquishment of more than one (1) child.

• The parent who signs the form translated in his/her native language is not required to sign the English version of it.

1. If signed in California, ensure that the parent signs the Statement of Understanding in the presence of the APRD CSW and two (2) witnesses who are at least eighteen (18) years of age. The APRD CSW cannot be a witness.

1. If signed out-of-state, ensure that:

1. The parent signed it in the presence of an authorized child welfare services agency representative or a notary public.

1. It is a California Department of Social Services (CDSS) authorized form.

1. If a reader or translator is used by an out-of-state agency, he/she is verified by the out-of-state agency. If the parent resides out-of-state, he/she will be referred to an authorized or accredited adoption in that state, and the Statement of Understanding can be signed before a notary.

1. If signed outside of the United States, ensure that the parent signs the Statement of Understanding in the presence of one (1) of the following:

• A minister, commissioner, or charge d'affaires of the United States who resides and who is an accredited representative of the United States in the country where the proof of acknowledgement is made

• A consul, vice consul, or consular agent of the United States who resides and is a representative of the United States in the country where the proof of acknowledgement is made

• A judge of a court of record from the country where the proof of acknowledgement is made

• A commissioner appointed by the Governor or Secretary of State for that purpose

• A notary public. In such a case, the signature of the notary public must be proved or acknowledged before a judge of a court of record of the country where the proof of acknowledgement is made, by any American diplomatic officer, consul general, consul, vice consul, or consular agent, or by an apostille (certification) affixed to the instrument pursuant to the terms of the Hague Convention Abolishing the Requirement of Legalization for Foreign Public Documents.

1. Provide the parents with a copy of the signed Statement of Understanding.

1. Explain to the parent that he/she has the option of waiting a maximum of fourteen (14) calendar days before signing the relinquishment document.

• Explain that if that time elapses, a new Statement of Understanding must be signed if he/she wishes to relinquish.

Back to Procedure

Discussing Filing Options and Time Frames

APRD CSW Responsibilities

1. Inform the relinquishing parent(s) that:

• He/she has the option of requesting the signed relinquishment document be filed without a holding period.

• Explain that the relinquishment document is not sent to the state until the end of the next business day after signing.

• He/she has the option of requesting that the signed relinquishment document be held by DCFS for a specified period of time for up to thirty (30) calendar days before it is submitted for filing.

• The signed relinquishment document will be held for more than thirty (30) calendar days, if questions about the right of any other parent to legal custody of the child have not been resolved.

1. If a signed relinquishment document will be held for more than thirty (30) days due to unresolved questions regarding the child's custody:

1. Explain to the relinquishing parent that the parent and the APRD CSW must mutually agree and sign a written statement, which indicates that it is necessary to hold the relinquishment document for an extended period of time.

1. Ensure that the written statement specifies the time period the relinquishment document will be held and the reason for holding the document for more than thirty (30) calendar days.

1. If the specific number of days cannot be stated in advance, the extended period ends when the APRD CSW becomes aware of the resolution regarding all other parent's right to legal custody of the child.

1. Inform the relinquishing parent in writing within three (3) business days of becoming aware of the resolution of the custody issues that the extended period will end five (5) business days after the date the notice to the relinquishing parent is sent.

1. Explain to the relinquishing parent that he/she is permitted to revoke his/her relinquish at any time prior to the expiration of any holding period and at any time before the relinquishment document is filed with the California Department of Social Services (CDSS). A relinquishment document becomes final ten (10) business days after CDSS receives the filing.

1. Explain that if the last day of the holding period falls on a weekend or legal holiday, DCFS allows parents to revoke the relinquishment on the next business day following the weekend or holiday.

1. Explain that DCFS will not place the child for adoption prior to the relinquishment document being filed with CDSS.

Back to Procedure

Accepting the Relinquishment Document

APRD CSW Responsibilities

1. Accept the relinquishment document, if any of the following criteria are met:

• The parent is able to understand the content, nature, and effect of signing the relinquishment document.

• If the parent underwent a psychiatric evaluation, the document was signed no later than thirty (30) days after his/her psychiatric evaluation was completed.

• If the court has appointed a conservator for the parent, both the order of conservatorship specifically allows the parent to relinquish his/her child for adoption and the psychiatric evaluation establishes the parent's ability to understand the content, nature, and effect of the relinquishing the child for adoption.

• The parent has signed the SOC 155, Voluntary Placement Agreement--Placement Request, and the AD 22, Health Facility Minor Release Report, if the child is in a health facility.

• The Statement of Understanding has been signed and initialed by the parent.

1. If the child is a newborn, accept the relinquishment document if all of the following are met:

• The mother has been medically discharged from the hospital.

• The exception is when the mother's stay is delayed beyond five (5) days. In this case, obtain a written statement from the attending physician that she is not suffering from a known physical or mental impairment, which would preclude her from relinquishing the child for adoption.

• The mother has signed the SOC 155 and the AD 22, if the child is in a health facility.

• The mother has initialed and signed the Statement of Understanding.

Back to Procedure

Selecting the Appropriate Relinquishment Document

APRD CSW Responsibilities

1. Choose one (1) of the appropriate documents to complete from the list of Required Relinquishment Forms.

• For Indian children, adhere to the procedures outline in Adopting and Serving Children Under the Indian Child Welfare Act (ICWA).

1. Enter the following information on the appropriate relinquishment form:

• Child's name, sex, date of birth, and place of birth as stated on his/her birth certificate

1. Ensure that a copy of the child's birth certificate has been obtained.

1. If there is a discrepancy between the name of the child on the relinquishment document and the name on the birth certificate, complete an affidavit explaining the discrepancy.

1. Attach a copy of the affidavit to the copy of the relinquishment document when it is sent to the California Department of Social Services (CDSS) to be filed and when the finalization packet is submitted for approval.

• Name of the relinquishing parent as it appears on the child's birth certificate. If the parent is not named on the child's birth certificate, the parent must sign his/her legal name

1. Include all of the parent's aliases that are used in legal transactions.

• Name of the adoption agency (DCFS Adoptions & Permanency Resource Division) and the office address and telephone number of the APRD CSW who is signing the relinquishment

• If the relinquishing parent chooses to designate a person to adopt the child, the designated person's name

Determining if the Relinquishment Document can be Signed

APRD CSW Responsibilities

1. If it is appropriate for a parent to sign a relinquishment document, give the appropriate original and three (3) copies of the relinquishment document to the parent to sign.

• The relinquish document must have original signatures.

• The relinquishment document cannot be altered or corrected unless it is initialed by the parent who signed the document, the reader or translator (if applicable) APRD CSW, and the witnesses to the relinquishment.

1. If signed in Los Angeles County, ensure that these forms are signed in the presence of the APRD CSW and two (2) other witnesses.

• The witnesses must be at least eighteen (18) years of age and cannot be the APRD CSW who is also signing the document.

1. If signed out-of-state, ensure that these forms are signed in the presence of an authorized or accredited adoption agency or before a notary public.

• Ensure that the use of a reader or translator by an out-of-state agency, if verified by the out-of-state agency.

1. If signed outside of the United States, ensure that an appropriate person witnesses the parent's signature.

1. At the time the relinquishment document is signed:

1. Request that the parent read the AD 908, Adoptions Information Act Statement, and sign two (2) copies of the form.

1. Advise the parent of the provisions of Family Code (FAM) Section 8701.

1. Sign the "authorized official" portion of the three (3) relinquishment documents.

1. Give the parent a copy of the completed relinquishment document and keep two (2) copies for the case record.

1. If the child has been temporarily placed with DCFS and the birth mother has not signed the relinquishment document within thirty (30) days of signing the SOC 155, Voluntary Placement Agreement-Placement Request, follow all procedures outlined in Voluntary Placement.

1. Within five (5) months from the date the SOC 155 or SOC 155C was signed, file a WIC 300 petition, if any of the following situations exist:

• One (1) or both birth parents have not followed through with voluntarily relinquishing the child.

• The child has been voluntarily relinquished but not adoptively relinquished. The exception is when the following one (1) situation has occurred:

• The birth mother has signed a relinquishment document.

• An acknowledgement of the relinquishment was issued.

• The child was adoptively placed prior to the end of the six (6) month period.

• There is a legal action under Family Code (FAM) Section 7662 pending on the alleged father.

Notifying the Court of a Dependent Parent's Relinquishment

For all pre-disposition cases, it is the responsibility of the Dependency Investigator (DI) to provide notification of a parent's relinquishment to the court.

APRD CSW or DI Responsibilities

1. If the child is a dependent of the court and once the birth parent has signed the relinquishment document:

1. Immediately notify the case-carrying CSW.

1. Review the online case record to ensure that all identifying information is recorded and current. Update the case record as necessary.

1. As soon as information of the relinquishment by the parent is obtained, create the Ex Parte Application and Order by referring to the Sample Ex Parte Application and Order Report.

1. When the report is created, a dialogue box appears titled, "Ex Parte Application and Order Document Options".

1. Select "Other".

1. Complete all appropriate fields on the report that are not populated by CWS/CMS.

1. Manually enter any information not found in the application.

1. Provide written notice to the following individuals within five (5) business days of the parent signing the relinquishment via the Ex Parte Application and Order:

• Case-carrying CSW

• Juvenile court having jurisdiction of the child

• Relinquishing parent's attorney, if applicable

• Child's attorney

1. Request online approval for the Ex Parte Application and Order.

1. Print the report.

1. Sign and date the hard copy.

1. Submit the hard copy of the Ex Parte Application and Order, and, if applicable, all supporting documents (e.g. permanency planning and/or adoption assessment) to the SCSW for approval. For post-disposition cases, a Concurrent Planning Assessment (CPA) is submitted with the Ex Parte Application and Order only when all of the parents of a child have relinquished him/her.

1. Do not attach the signed relinquishment documents to the court report.

1. If the court ordered DCFS to submit the relinquishment documents, consult with the County Counsel.

1. If advised to submit the documents to the court, place the relinquishment documents in a sealed envelope and label it with the following information:

• Court room and court case number

• Child's name

• The phrase, "For Court Eyes Only"

1. Document that the relinquishment documents were submitted to the court in the Contact Notebook.

1. If the Ex Parte Application and Order was not approved, take necessary corrective action and resubmit the report for approval.

1. When the report is approved, send it and all attachments to DCFS support staff for final preparation and delivery to the court.

• Ensure that it is delivered to the court by noon prior to the fifth (5th) day after obtaining information on the relinquishment.

1. Fax a copy of the report no later than five (5) business days after the parent(s) relinquish the child to the child's attorney and the relinquishing parent's attorney, if applicable.

• File the fax transmission confirmation sheet in the Court Document folder of the case file.

1. Upon receipt of the minute order, ensure that the correct hearing date is entered in the Hearing Notebook.

• Update the default date of "12/31/2001" with the date the case was heard.

SCSW Responsibilities

1. Review the relinquishment packet that includes the Ex Parte Application and Order and any supporting documents.

1. If approved:

1. Sign and date the Ex Parte Application and Order.

1. Approve the Ex Parte Application and Order online.

1. Return the packet to the APRD CSW.

1. If not approved, request corrective action online, and return the packet to the CSW.

Back to Procedure

Assisting a Parent who Cannot Read Relinquishment Documents

APRD CSW Responsibilities

Adhere to the following procedures if a parent who must sign a relinquishment, consent, or Statement of Understanding form cannot read English but does read his/her native language.

1. Check the California Department of Social Services (CDSS) website for forms that have already been translated.

• If additional information is needed, contact the CDSS Language Services Unit at (916) 651-8865 or to obtain a translated copy of the appropriate document.

1. If CDSS cannot provide the translated forms within a reasonable time frame, permit the parent to provide a certified translator:

• The certified translator will attach the English version of the form to the translated form and include a signed DCFS/A 409, Adoptions & Permanency Resources Division Reader's/ Translator's Statement, that attests to the accuracy of the translation.

1. If the parent cannot provide a translator, provide a certified DCFS translator.

• The DCFS translator will attach the English version of the required forms to the translated forms and include a signed DCFS/A 409, attesting to the accuracy of the translation.

• Before using the translated forms, fax the forms to the CDSS Adoptions Branch Forms Coordinate at (916) 651-8106 to determine the accuracy of the translation.

1. If the parent signing the statement cannot read any language:

1. Provide the forms that can be read to the parent in a language that he/she understands.

1. Obtain translated forms from the CDSS Language Services Unit.

1. If applicable, permit the parent his/her own reader.

1. If a parent cannot locate a reader, provide a DCFS employed reader who is certified in the language to be read.

1. Consult with the chain of command if there is not a DCFS employee that speaks the language.

1. Audio record or videotape the reading of the forms to the parent.

1. Consult with the SCSW or the ARA for information on obtaining tapes and recording equipment.

1. File the tape in the adoption folder.

1. Include a signed DCFS/A 409, attesting that the forms were accurately read.

1. Determine if the parent has a clear understanding of the information contained in the relinquishment, consent, and Statement of Understanding.

1. If he/she does, proceed with having him/her sign the forms.

• He/she does not need to sign the English versions of these forms.

1. If he/she does not, inform him/her that the forms cannot be signed until the information has been clarified.

1. Ensure that the parent signs the relinquishment, consent, and Statement of Understanding using his/her legal signature and that he/she includes all aliases used in legal transactions.

Back to Procedure

APPROVALS

SCSW Approval

• Ex Parte Application and Order

HELPFUL LINKS

Attachments

Alternative Forms of Adoption

Required Relinquishment Forms

Sample Ex Parte Application and Order Report

Forms

CWS/CMS

AD 22, Health Facility Minor Release Report

AD 100A, Authorization for Use and/or Disclosure of Heath Information Agency Adoption Program

AD 501, Relinquishment In or Out-of-County (Birth Mother and/or Presumed Father in California)

AD 501A, Relinquishment Out-of-State (Birth Mother and/or Presumed Father)

AD 504, Relinquishment Out-of-State in the Armed Forces (Birth Mother and/or Presumed Father)

AD 583, Relinquishment In or Out-of-County (Presumed Father Denies He is the Birth Father)

AD 584, Relinquishment Out-of-State (Presumed Father Denies He is the Birth Father)

AD 586, Relinquishment In- or Out-of-County (Alleged Natural Father in California)

AD 588, Denial of Paternity by Alleged Natural Father (In or Out of California)

AD 590, Waiver of Right to Further Notice of Adoption Planning (Alleged Natural Father In- or Out-if California)

AD 590A, Waiver of Right to Further Notice of Adoption Planning (Presumed Father In- or Out-of-California)

AD 591, Relinquishment Out-of-State (Alleged Natural Father)

AD 593, Relinquishment Out-of-State in Armed Forces (Alleged Natural Father), if signing before a military officer

AD 885, Statement of Understanding Agency Adoption Programs – A Mother or a Presumed Father of a Child Who is Not Detained, a Juvenile Court Dependent in Out-of-Home Care, or the Ward of a Legal Guardian

AD 885A, Statement of Understanding Agency Adoption Programs – A Mother or a Presumed Father of a Child Who is Detained, a Juvenile Court Dependent in Out-of-Home Care, or the Ward of a Legal Guardian

AD 885C, Statement of Understanding Agency Adoptions Program – Alleged Natural Father of a Child Who is Not Detained, a Juvenile Court Dependent in Out-of-Home Care, or the Ward of a Legal Guardian

AD 885D, Statement of Understanding Agency Adoptions Program – Alleged Natural Father of a Child Who is Detained, a Juvenile Court Dependent in Out-of-Home Care, or the Ward of a Legal Guardian

AD 908, Adoptions Information Act Statement

AD 4339, Relinquishment Out-of-State (Birth Mother and/or Presumed Father)

LA Kids

AD 67, Information about the Birth Mother (Spanish)

AD 67A, Information about the Birth Father (Spanish)

DCFS/A 409, Adoptions & Permanency Resources Division Reader's/ Translator's Statement

SOC 155, Voluntary Placement Agreement--Placement Request

SOC 155C, Voluntary Placement Agreement Parent/Agency (Indian Child)

Hard Copy

AD 4333, Acknowledgement and Confirmation of Receipt of Relinquishment Documents

DCFS/A 14, Parent's Request for Service

Referenced Policy Guides

0080-502.25, Family Maintenance Services for Court and Voluntary Cases

0080-507.20, Concurrent Planning and the Concurrent Planning Assessment (CPA)

0100-510.21, Voluntary Placement

0200-507.10, Identifying a Prospective Adoptive Family for a Child through the Placement and Recruitment Unit (PRU)

0200-508.25, Filing, Revoking, and Rescinding a Relinquishment

0200-513.05, Postadoption Contact Agreements

0300-303.15, Writing the Detention Report

0300-503.99, Change of Permanent Plan from Legal Guardianship to Adoption

1200-500.05, Adopting and Serving Children Under the Indian Child Welfare Act (ICWA)

Statutes

California Department of Social Service (CDSS), Adoptions Manual, Title 22, Section 35003 – Summarizes the procedures used with regards to relinquishment and consent procedures for parents who cannot read English or any other language.

CDSS, Title 22, Div 2, Adoptions Manual Sections 35129.1 – 25129.2 – Explains the advisement that birth parents should receive regarding their rights when placing a child for adoption.

CDSS, Title 22, Div 2, Adoptions Manual, Sections 35130 – 35149 – Summarizes instructions on accepting a relinquishment.

CDSS, Title 22, Div 2, Adoptions Manual, Sections 35151 – 35152.1 – Summarizes instructions for the Statement of Understanding.

Family Code (FAM) Section 7611 – States the conditions for when a man is presumed to be the natural father of a child.

FAM Section 7660.5 – States, in part, how a presumed father may waive the right to notice of any adoption proceeding.

FAM Section 7662 – Summarizes when a petition should be filed to terminate the parental rights of a father when a birth mother relinquishes, consents to, or proposes to relinquish for the adoption of a child.

FAM Section 7662(b) – States, in part, that a birth father may validly execute a waiver or a denial of paternity before or after the birth of a child and that, once signed, no notice of, relinquishment for, or consent to adoption of the child is required from the birth father for the adoption to proceed.

FAM Section 8620(a)(1) – States, in part, that if a parent is seeking to relinquish a child or to execute an adoptive placement agreement, DCFS will ask the child and the child's parents/legal guardian whether the child is, or may be, a member of an Indian tribe.

FAM Section 8700(c) – States, in part, when a California adoption agency can accept a relinquishment from a parent not residing in California.

FAM Section 8700(i) – States, in part, DCFS must provide notice of the relinquishment of a child who is within WIC Section 300 or who is the subject of a petition for juvenile court jurisdiction under WIC 300 within five (5) court days to those indicated.

FAM Section 8701 – States, in part that before, or any time after, the relinquishment document is signed, the birth parent signing it may request from DCFS all known information about the status of the child's adoption, except for personal, specified, identifying information about the adoptive parent(s).

FAM Section 8702 – States, in part, when a relinquishment document is signed by the birth parents, a statement is to be presented that ensures the birth parents and prospective adoptive parents of the integrity of the adoption process.

FAM Section 8801 – States, in part, that the selection of a prospective adoptive parent is to be personally made by the child's birth parent(s) and not delegated to an agent.

Welfare and Institutions Code (WIC) Section 300 – Details the criteria that a child must meet to be adjudged by the juvenile court as a dependent of the court.

WIC Section 11400(o) – Outlines the provisions of a voluntary placement.

WIC Section 16507.2 – States that prior to entering a voluntary placement agreement with a parent or legal guardian, the social worker will make every attempt to keep the family together by offering the appropriate child welfare services except in the case of a voluntary placement that is pending relinquishment.

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