Title 45: Public Welfare
PART 1355—GENERAL
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Appendix D to Part 1355—Foster Care and Adoption Record Layouts
A. Foster Care
1. Foster Care Semi-Annual Detailed Data Elements Record
a. The record will consist of 66 data elements.
b. Data must be supplied for each of the elements in accordance with these instructions:
(1) All data must be numeric. Enter the appropriate value for each element.
(2) Enter date values in year, month and day order (YYYYMMDD), e.g., 19991030 for October 30, 1999, or year and month order (YYYYMM), e.g., 199910 for October 1999. Leave the element value blank if dates are not applicable.
(3) For elements 8, 11–15, 26–40, 52, 54 and 59–65, which are “select all that apply” elements, enter a “1” for each element that applies, enter a zero for non-applicable elements.
(4) Transaction Date—is a computer generated date indicating when the datum (Elements 21 or 55) is entered into the State's automated information system.
(5) Report the status of all children in foster care as of the last day of the reporting period. Also, provide data for all children who were discharged from foster care at any time during the reporting period, or in the previous reporting period, if not previously reported.
c. Foster Care Semi-Annual Detailed Data Elements Record Layout follows:
---------------------------------------------------------------------------------------------------------------- No. of Element No. Appendix A data element Data element description numeric characters----------------------------------------------------------------------------------------------------------------01.......................... I.A................................ State........................... 202.......................... I.B................................ Report period ending date....... 603.......................... I.C................................ Local Agency FIPS code (county 5 or equivalent jurisdiction).04.......................... I.D................................ Record number................... 1205.......................... I.E................................ Date of most recent periodic 8 review.06.......................... II.A............................... Child's date of birth........... 807.......................... II.B............................... Sex............................. 108.......................... II.C.1............................. Race............................08a......................... ................................... American Indian or Alaska native 108b......................... ................................... Asian........................... 108c......................... ................................... Black or African American....... 108d......................... ................................... Native Hawaiian or Other Pacific 1 Islander.08e......................... ................................... White........................... 108f......................... ................................... Unable to Determine............. 109.......................... II.C.2............................. Hispanic or Latino Ethnicity.... 110.......................... II.D............................... Has this child been clinically 1 diagnosed as having a disability(ies). Indicate each type of disability of the child with a ``1'' for elements 11-15 and a zero for disabilities that do not apply.11.......................... II.D.1.a........................... Mental retardation.............. 112.......................... II.D.1.b........................... Visually or hearing impaired.... 113.......................... II.D.1.c........................... Physically disabled............. 114.......................... II.D.1.d........................... Emotionally disturbed (DSM III). 115.......................... II.D.1.e........................... Other medically diagnosed 1 condition requiring special care.16.......................... II.E.1............................. Has this child ever been adopted 117.......................... II.E.2............................. If yes, how old was the child 1 when the adoption was legalized?.18.......................... III.A.1............................ Date of first removal from home. 819.......................... III.A.2............................ Total number of removals from 2 home to date.20.......................... III.A.3............................ Date child was discharged from 8 last foster care episode.21.......................... III.A.4............................ Date of latest removal from home 822.......................... III.A.5............................ Removal transaction date........ 823.......................... III.B.1............................ Date of placement in current 8 foster care setting.24.......................... III.B.2............................ Number of previous placement 2 settings during this removal episode.25.......................... IV.A............................... Manner of removal from home for 1 current placement episode. Actions or conditions associated with child's removal: Indicate with a ``1'' for elements 26-40 and a zero for conditions that do not apply.26.......................... IV.B.1............................. Physical abuse (alleged/ 1 reported).27.......................... IV.B.2............................. Sexual abuse (alleged/reported). 128.......................... IV.B.3............................. Neglect (alleged/reported)...... 129.......................... IV.B.4............................. Alcohol abuse (parent).......... 130.......................... IV.B.5............................. Drug abuse (parent)............. 131.......................... IV.B.6............................. Alcohol abuse (child)........... 132.......................... IV.B.7............................. Drug abuse (child).............. 133.......................... IV.B.8............................. Child's disability.............. 134.......................... IV.B.9............................. Child's behavior problem........ 135.......................... IV.B.10............................ Death of parent(s).............. 136.......................... IV.B.11............................ Incarceration of parent(s)...... 137.......................... IV.B.12............................ Caretaker's inability to cope 1 due to illness or other reasons.38.......................... IV.B.13............................ Abandonment..................... 139.......................... IV.B.14............................ Relinquishment.................. 140.......................... IV.B.15............................ Inadequate housing.............. 141.......................... V.A................................ Current placement setting....... 142.......................... V.B................................ Out of State placement.......... 143.......................... VI................................. Most recent case plan goal...... 144.......................... VII.A.............................. Caretaker family structure...... 145.......................... VII.B.1............................ Year of birth (1st principal 4 caretaker).46.......................... VII.B.2............................ Year of birth (2nd principal 4 caretaker).47.......................... VIII.A............................. Date of mother's parental rights 8 termination.48.......................... VIII.B............................. Date of legal or putative 8 father's parental rights.49.......................... IX.A............................... Foster family structure......... 150.......................... IX.B.1............................. Year of birth (1st foster 4 caretaker).51.......................... IX.B.2............................. Year of birth (2nd foster 4 caretaker).52.......................... IX.C.1............................. Race of 1st foster caretaker....52a......................... ................................... American Indian or Alaska Native 152b......................... ................................... Asian........................... 152c......................... ................................... Black or Asian American......... 152d......................... ................................... Native Hawaiian or Other Pacific 1 Islander.52e......................... ................................... White........................... 152f......................... ................................... Unable to Determine............. 153.......................... IX.C.2............................. Hispanic or Latino ethnicity of 1 1st foster caretaker.54.......................... IX.C.3............................. Race of 2nd foster caretaker....54a......................... ................................... American Indian or Alaska Native 154b......................... ................................... Asian........................... 154c......................... ................................... Black or African American....... 154d......................... ................................... Native Hawaiian or Other pacific 1 islander.54e......................... ................................... White........................... 154f......................... ................................... Unable to Determine............. 155.......................... IX.C.4............................. Hispanic or Latino ethnicity of 1 2nd foster caretaker.56.......................... X.A.1.............................. Date of discharge from foster 8 care.57.......................... X.A.2.............................. Foster care discharge 8 transaction date.58.......................... X.B................................ Reason for discharge............ 1 Sources of Federal support/ assistance for child; indicate with a ``1'' for elements 58-64 and a zero for sources that do not apply.59.......................... XI.A............................... Title IV-E (Foster Care)........ 160.......................... XI.B............................... Title IV-E (Adoption Assistance) 161.......................... XI.C............................... Title IV-A (Aid to Families With 1 Dependent Children).62.......................... XI.D............................... Title IV-D (Child Support)...... 163.......................... XI.E............................... Title XIX (Medicaid)............ 164.......................... XI.F............................... SSI or other Social Security Act 1 benefits.65.......................... XI.G............................... None of the above............... 166.......................... XII................................ Amount of monthly foster care 5 payment (regardless of source). ------------ Total characters............... 197----------------------------------------------------------------------------------------------------------------
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2. Foster Care Semi-Annual Summary Data Elements Record
a. The record will consist of 22 data elements.
The values for these data elements are generated by processing all records in the semi-annual detailed data transmission and computing the summary values for Elements 1 and 3–22. Element 2 is the semi-annual report period ending date. In calculating the age range for the child, the last day of the reporting period is to be used.
b. Data must be supplied for each of the elements in accordance with these instructions:
(1) Enter the appropriate value for each element.
(2) For all elements where the total is zero, enter a numeric zero.
(3) Enter date values in year, month order (YYYYMM), e.g.,199912 for December 1999.
c. Foster Care Semi-Annual Summary Data Elements Record Layout follows:
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------------------------------------------------------------------------ No. of Element No. Summary data file characters------------------------------------------------------------------------01......................... Number of records......... 802......................... Report period ending date 6 (YYYYMM).03......................... Children in care under 1 8 year.04......................... Children in care 1 year 8 old.05......................... Children in care 2 years 8 old.06......................... Children in care 3 years 8 old.07......................... Children in care 4 years 8 old.08......................... Children in care 5 years 8 old.09......................... Children in care 6 years 8 old.10......................... Children in care 7 years 8 old.11......................... Children in care 8 years 8 old.12......................... Children in care 9 years 8 old.13......................... Children in care 10 years 8 old.14......................... Children in care 11 years 8 old.15......................... Children in care 12 years 8 old.16......................... Children in care 13 years 8 old.17......................... Children in care 14 years 8 old.18......................... Children in care 15 years 8 old.19......................... Children in care 16 years 8 old.20......................... Children in care 17 years 8 old.21......................... Children in care 18 years 8 old.22......................... Children in care over 18 8 years old. ---------------- Record Length............ 174------------------------------------------------------------------------
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B. Adoption
1. Adoption Semi-Annual Detailed Data Elements Record
a. The record will consist of 37 data elements.
b. Data must be supplied for each of the elements in accordance with these instructions:
(1) Enter the appropriate value for each element.
(2) Enter date values in year, month and day order (YYYYMMDD), e.g., 19991030 for October 30, 1999, or year and month (YYYYMM), e.g., 199910 for October 1999. Leave the element value blank if dates are not applicable.
(3) For elements 7, 11–15, 25, 27 and 29–32 which are “select all that apply” elements, enter a “1” for each element that applies; enter a zero for non-applicable elements.
c. Adoption Semi-Annual Detailed Data Elements Record Layout follows:
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---------------------------------------------------------------------------------------------------------------- No. of Element No. Appendix B data element Data element description numeric characters----------------------------------------------------------------------------------------------------------------01.......................... I.A................................ State........................... 202.......................... I.B................................ Report period ending date....... 603.......................... I.C................................ Record number................... 604.......................... I.D................................ State Agency involvement........ 105.......................... II.A............................... Date of birth................... 606.......................... II.B............................... Sex............................. 107.......................... II.C.1............................. Race............................07a......................... ................................... American Indian or Alaska Native 107b......................... ................................... Asian........................... 107c......................... ................................... Black or African American....... 107d......................... ................................... Native Hawaiian or Other Pacific 1 Islander.07e......................... ................................... White........................... 107f......................... ................................... Unable to Determine............. 108.......................... II.C.2............................. Hispanic or Latino ethnicity.... 109.......................... III.A.............................. Has the State Agency determined 1 that this child has special needs.10.......................... III.B.............................. Primary basis for special needs. 1 Indicate a primary basis of special needs with a ``1'' for elements 11-15. Enter a zero for special needs that do not apply.11.......................... III.B.1.a.......................... Mental retardation.............. 112.......................... III.B.1.b.......................... Visually or hearing impaired.... 113.......................... III.B.1.c.......................... Physically disabled............. 114.......................... III.B.1.d.......................... Emotionally disturbed (DSM III). 115.......................... III.B.1.e.......................... Other medically diagnosed 1 condition requiring special care.16.......................... IV.A.1............................. Mother's year of birth.......... 417.......................... IV.A.2............................. Father's (Putative or legal) 4 year of birth.18.......................... IV.B............................... Was the mother married at time 1 of child's birth.19.......................... V.A.1.............................. Date of mother's termination of 8 parental rights.20.......................... V.A.2.............................. Date of father's termination of 8 parental rights.21.......................... V.B................................ Date adoption legalized......... 822.......................... VI.A............................... Adoptive parents family 1 structure.23.......................... VI.B.1............................. Mother's year of birth (if 4 applicable).24.......................... VI.B.2............................. Father's year of birth (if 4 applicable).25.......................... VI.C.1............................. Adoptive mother's race..........25a......................... ................................... American Indian or Alaska Native 125b......................... ................................... Asian........................... 125c......................... ................................... Black or African American....... 125d......................... ................................... Native Hawaiian or Other Pacific 1 Islander.25e......................... ................................... White........................... 125f......................... ................................... Unable to Determine............. 126.......................... VI.C.2............................. Hispanic or Latino Ethnicity.... 127.......................... VI.C.3............................. Adoptive father's race..........27a......................... ................................... American Indian or Alaska Native 127b......................... ................................... Asian........................... 127c......................... ................................... Black or African American....... 127d......................... ................................... Native Hawaiian or Other Pacific 1 Islander.27e......................... ................................... White........................... 127f......................... ................................... Unable to Determine............. 128.......................... VI.C.4............................. Hispanic or Latino Ethnicity.... 1 Indicate each type of relationship of adoptive parent(s) to the child with a ``1'' for elements 29-32. Enter a zero for relationships that do not apply below.29.......................... VI.D.1............................. Stepparent...................... 130.......................... VI.D.2............................. Other relative of child by birth 1 or marriage.31.......................... VI.D.3............................. Foster parent of child.......... 132.......................... VI.D.4............................. Other non-relative.............. 133.......................... VII.A.............................. Child was placed from........... 134.......................... VII.B.............................. Child was placed by............. 135.......................... VIII.A............................. Is this child receiving a 1 monthly subsidy.36.......................... VIII.B............................. If VIII.B is ``yes.'' What is 5 the monthly amount.37.......................... VIII.C............................. If VII.B is ``yes.'' Is the 1 child receiving title IV-E adoption assistance?. ................................... Total Characters............... 111----------------------------------------------------------------------------------------------------------------
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2. Adoption Semi-Annual Summary Data Elements Record
a. The record will consist of 22 data elements.
The values for these data elements are generated by processing all records in the semi-annual detailed data transmission and computing the summary values for Elements 1 and 3–22. Element 2 is the semi-annual report period ending date. In calculating the age range for the child, the last day of the reporting period is to be used.
b. Data must be supplied for each of the elements in accordance with these instructions:
(1) Enter the appropriate value for each element.
(2) For all elements where the total is zero, enter a numeric zero.
(3) Enter data values in year, month order (YYYYMM), e.g., 199912 for December 1999.
c. Adoption Semi-Annual Summary Data Element Record Layout follows:
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------------------------------------------------------------------------ No. of Element No. Summary data file characters------------------------------------------------------------------------01......................... Number of records......... 802......................... Report period ending date 6 (YYYYMM).03......................... Children adopted Under 1 8 year old.04......................... Children adopted 1 year 8 old.05......................... Children adopted 2 years 8 old.06......................... Children adopted 3 years 8 old.07......................... Children adopted 4 years 8 old.08......................... Children adopted 5 years 8 old.09......................... Children adopted 6 years 8 old.10......................... Children adopted 7 years 8 old.11......................... Children adopted 8 years 8 old.12......................... Children adopted 9 years 8 old.13......................... Children adopted 10 years 8 old.14......................... Children adopted 11 years 8 old.15......................... Children adopted 12 years 8 old.16......................... Children adopted 13 years 8 old.17......................... Children adopted 14 years 8 old.18......................... Children adopted 15 years 8 old.19......................... Children adopted 16 years 8 old.20......................... Children adopted 17 years 8 old.21......................... Children adopted 18 years 8 old.22......................... Children adopted over 18 8 years old. ---------------- Record Length............ 174------------------------------------------------------------------------
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[58 FR 67931, Dec. 22, 1993; 59 FR 13535, Mar. 22, 1994; 59 FR 42520, Aug. 18, 1994, as amended at 60 FR 40507, Aug. 9, 1995; 65 FR 4085, Jan. 25, 2000]
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