Form 57 is a document used in the state of Georgia to declare the transfer of property. This form is used when there is a change in ownership, such as a sale or gift. The form must be filled out and filed with the county clerk's office within 30 days of the transfer. There are specific instructions for completing Form 57, so it is important to read and follow them carefully. Failing to do so may result in penalties.
Question | Answer |
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Form Name | Georgia Form 57 |
Form Length | 1 pages |
Fillable? | No |
Fillable fields | 0 |
Avg. time to fill out | 15 sec |
Other names | Islander, SSCM, childcare, CPS |
Date Received by CAPS
Georgia Department of Human Resources
CHILD CARE REFERRAL & APPLICATION FOR SUPPLEMENTAL SUPERVISION
___________ County Department of Family and Children Services
A. FOSTER CHILD INFORMATION (To be completed by SSCM)
First Name MI Last Name Sex
Date |
Social Security |
Child |
Child |
of |
Number |
in |
in |
Birth |
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School |
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Child
in
Head
Start
Child has a disability
Ethnicity (check one): |
Hispanic |
Not Hispanic |
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Race (check one): |
White |
Black/African American |
Asian |
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American Indian or Alaskan Native |
Native Hawaiian or other Pacific Islander |
B. FOSTER CARE PLACEMENT INFORMATION (To be completed by SSCM)
Foster Parent's Name
Address
Home Phone
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Work Phone # |
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If an informal childcare provider has been chosen, check all that apply: |
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Relative of Child |
Care provided in child's home |
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CRC completed |
Care provided in provider's home |
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CPS screening completed |
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Approved by Foster Care |
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All changes in the child's placement and child care arrangements MUST be reported to the child care case manager within 5 working days.
____________________________________ |
________________ |
_______________ |
Signature of Foster Care Case Manager |
Date |
Case Load ID # |
C. CHILD CARE PROVIDER INFORMATION (To be completed by the SSCM or Foster Parent)
Reason Care is Needed:
Days and Hours Care is Needed:
Date to begin CAPS: _____
Name, Address and Phone # of Childcare Provider:
Phone # :
D. ELIGIBILITY DETERMINATION (To be completed by the CAPS case manager)
1. |
Family Unit Size |
____ |
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4. |
Rate Within DFCS Maximum? |
Yes |
No |
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2. |
UAS Code (check one): |
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Cost of care if not within maximum $_________ |
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555 |
557 |
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3. |
Provider is: |
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5. |
Application Disposition: |
Approved |
Denied |
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Licensed, Commissioned, or Exempt |
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Registered |
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6. |
Official Certification Period: |
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Informal- Relative of Child |
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___________________ to __________________ |
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Informal- |
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Comments:
________________________________ |
_____________________ |
_____________________ |
Signature of CAPS Case Manager |
Date |
CAPS Case Load ID # |
Form 57 (3/2004) |
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