Mdhs ss 482 is a state form that is used to request temporary custody of a child. The form can be used by any individual who has physical custody of the child, or by an agent or attorney representing the individual. The form must be submitted to the local juvenile services agency, and must include detailed information about the situation requiring custody. A copy of the form must also be provided to the child's parent or legal guardian.
| Question | Answer |
|---|---|
| Form Name | Form Mdhs Ss 482 |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | applicants, Resource, mdhs wage form, regisri |
MISSISSIPPI
FORM
Revised
|
Date |
TO: |
Child Abuse Central Registry |
|
Division ofFamily &Children's Services |
|
Office ofSocial Services |
|
P.O. Box 352 |
|
Jackson,MS 39205 |
FROM: Name
Title
Agency
Address
Please check the central registry for the following applicant for:
•Foster/Adoption:
•MDHS Employee:
•Relative Resource Parent:
•Priority Processing (relative resowce parent only):
•Volunteer Internship:
• Other: |
(please specify) |
PLEASE PRINT
Name
Address
DOB
Social Security Number
Telephone number where applicant can be reached
I understand that this information must be kept confidential with my agency. I have on file a signed release form from the above applicants)for this information.
"fo be completed by MDHS Office ofFamily and Children's Service Staff
Findings:
No information found in the central
The following information was found in the central registry.
Signature |
__ Date |