Georgia Form 57 PDF Details

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.

QuestionAnswer
Form NameGeorgia Form 57
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesIslander, SSCM, childcare, CPS

Form Preview Example

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

 

School

Pre-K

 

 

 

 

Child

in

Head

Start

Child has a disability

Ethnicity (check one):

Hispanic

Not Hispanic

 

Race (check one):

White

Black/African American

Asian

 

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

 

 

 

Work Phone #

 

 

 

 

If an informal childcare provider has been chosen, check all that apply:

 

Relative of Child

Care provided in child's home

 

CRC completed

Non-Relative

Care provided in provider's home

 

CPS screening completed

 

 

 

Approved by Foster Care

 

 

 

 

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

____

 

4.

Rate Within DFCS Maximum?

Yes

No

2.

UAS Code (check one):

 

 

 

Cost of care if not within maximum $_________

 

 

555 (Pre-K)

557

 

 

 

 

 

3.

Provider is:

 

 

5.

Application Disposition:

Approved

Denied

 

Licensed, Commissioned, or Exempt

 

 

 

 

 

 

 

Registered

 

 

6.

Official Certification Period:

 

 

 

 

Informal- Relative of Child

 

 

___________________ to __________________

 

Informal- Non-Relative

 

 

 

 

 

 

 

Comments:

________________________________

_____________________

_____________________

Signature of CAPS Case Manager

Date

CAPS Case Load ID #

Form 57 (3/2004)

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