DPSS 3809 Form PDF Details

In the Riverside County Department of Public Social Services, individuals working with children's services may often encounter the DPSS 3809 form, an integral part of the Children's Services Placement Packet. This form serves as a Document Inventory Sheet, outlining all the essential documents contained within the left side of the packet. These documents range from informational brochures on child abuse and neglect reporting laws, available in both English and Spanish, to guides on legal guardianship, adoption, and family support. Additionally, the form includes caregiver incident report forms, instructions for filling out critical legal documents, and various pamphlets that offer insights into team decision-making, health and disability prevention programs, and the rights of individuals under California welfare programs. The packet is designed with precision to ensure that caregivers are thoroughly informed about the rights, responsibilities, and resources available to them, including necessary actions in case grievances need to be resolved or incidents reported. On the right side of the packet, one can find agreements between agencies and foster parents or group homes, placement requests, and a slew of verification and assessment forms crucial for ensuring the safety and well-being of placed children. Clearly, the DPSS 3809 form is a comprehensive resource that underscores the commitment of the Riverside County Department of Public Social Services to the welfare and proper care of children under its jurisdiction.

QuestionAnswer
Form NameDPSS 3809 Form
Form Length1 pages
Fillable?Yes
Fillable fields49
Avg. time to fill out10 min 7 sec
Other namesdpss1917, dpss 1917, riverside county dpss affidavit form, riverside county department of public social services affidavit form dpss 1917

Form Preview Example

Riverside County Department of Public Social Services – Children’s Services

Placement Packet Document Inventory Sheet – DPSS 3809

(Left Side of Packet)

Documents to Review with Caregiver

PUB 132 The Child Abuse and Neglect Reporting Law (Eng. & Span.)

PUB 395 You Have Rights Too! (Eng.)

PUB 13 Your Rights under California Welfare Programs (Eng., Span., & 14 other languages)

DPSS 3373A The Complaint Process (Eng. & Span.)

DPSS 3373

Resolving Grievances

DPSS 3694

Caregiver Incident Report

DPSS 3566

Instructions for JV-290

JV-290

Caregiver Information Form (Eng.,

 

Span., & 3 other languages)

PUB 183

Child Health & Disability Prevention

 

(CHDP) Program (Eng.)

PUB 184

Child Health & Disability Prevention

 

(CHDP) Program (Span.)

PM 357

CHDP Referral (Eng. only)

DPSS 2004

Verification of Dependent Medical

 

and Dental (Eng. or Span.)

N/A

JDP and CASA Case Manager E-

 

mail and Telephone List

DPSS 2787

A Guide to Legal Guardianship and

 

Adoption

DPSS 3333

Family Matters

DPSS 3372

Family Support Pamphlet

DPSS 3668

Team Decision Making Pamphlet

 

(Eng. or Span.)

Additional Items for Caregivers

Birth Certificate

Medical Card (i.e. Medi-Cal or personal insurance) Health & Education Passport

Immunization Card

Social Security Card

Medication currently required:

Other:

Caregiver’s Signature:

Date:

(Right Side of Packet)

Agreements

SOC 156 Agency-Foster Parent(s) Agreement

SOC 154 Agency-Group Home Agreement

DPSS 738 Placement Request

Relative/NREFM Placement Information

DPSS 2688 Agency-Relative/NREFM Placement Agreement

DPSS 3265 Verification of NREFM

DPSS 1765A Request for Criminal History Records Check (3 Copies)

DPSS 1917C Affidavit (3 Copies) (Eng. & Span.)

BCII 8016 Request for Live Scan Services (Carbonized Set of 3)

SOC 815 Approval of Family Caregiver Home

SOC 817 Checklist of Health and Safety Standards for Approval of Family Caregiver Home

SOC 818 Relative or NREFM Caregiver Assessment

DPSS 3413 Documented Alternative Plan (DAP) DPSS 3555 Relative/NREFM to RAU

DPSS 3558 Notification of a Choice of a Relative/ NREFM Caregiver by the Social Worker

DPSS 3612 Reference Letter Request

DPSS 3190 Potential Caregiver Letter (Eng. or Span.)

Documents for All Placement Types

DPSS 2724 Child’s Personal Belongings and Medication Inventory (Eng. or Span.)

DPSS 2757 Foster Child’s Needs and Case Plan Summary

DPSS 3231 Child’s Personal Rights Summary (Eng. or Span.)

DPSS 3637 Caregiver’s Authorization Affidavit (Eng. or Span.)

DPSS 2769 Statement of Dangerous Behavior

/Ambulatory Status

Social Worker’s Signature:

Date:

DPSS 3809 (08/09) Placement Packet Document Inventory Sheet

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