F.C.A.§§1089, 1089-A1 New York State Family Court County of ______________ Hearing Date: ____________ PRESENT: Hon. Judge ........................................................................... In the Matter of CIN # A Child or Children Under 21 Years of Age Alleged to be "Abused "Neglected " Voluntarily Placed " Destitute Form PH-5 (Permanency Hearing Order) 6/2016 Docket No. PERMANENCY HEARING ORDER Respondent(s) ........................................................................... NOTICE: IF YOUR CHILD(REN) STAY IN FOSTER CARE FOR 15 OF THE MOST RECENT 22 MONTHS, THE AGENCY MAY BE REQUIRED BY LAW TO FILE A PETITION TO TERMINATE YOUR PARENTAL RIGHTS AND MAY FILE BEFORE THE END OF THE 15-MONTH PERIOD. IF THE PETITION IS GRANTED, YOU MAY LOSE YOUR RIGHTS TO YOUR CHILD(REN) AND YOUR CHILD(REN) MAY BE ADOPTED WITHOUT YOUR CONSENT. THE NEXT COURT DATE IS [date/time]: ____________________ THE NEXT PERMANENCY HEARING SHALL BE HELD ON [date/time]:________________ An order having been issued directing that the child(ren) be placed or removed from the parent or person legally responsible for the child(ren) ; and " This hearing having been heard jointly with the " custody " guardianship petition, Docket #: __________________________ ; And the position and information provided by the local department of social services, as well as that of the child(ren) and others appearing before the Court, having been considered by the Court; And the following child(ren) having [check applicable box(es)]: " appeared " participated as follows [specify]: Child: " did not participate " appeared " participated as follows [specify]: Child: " did not participate " appeared " participated as follows [specify]: Child: " did not participate Note: If permanency planning goals, findings or other provisions of this order differ for different children, a separate permanency order for each child should be issued. American LegalNet, Inc. www.FormsWorkFlow.com 1 PH-5 Page 2 Reasonable Efforts Determination The Court makes the following findings regarding reasonable efforts to implement the permanency hearing goal in place at the commencement of this hearing: Reasonable efforts to make and finalize the permanency planning goal of [return to parent, adoption, guardianship, permanent placement with a fit and willing relative, or placement in another planned permanent living arrangement][specify]:_____________________________________ " were made as follows [specify reasonable efforts, including consideration of out-of-State resources:] ____________________________________________________________________ ______________________________________________________________________________ " were not made [specify]: _______________________________________________________ _____________________________________________________________________________ " The permanency goal is reunification and reasonable efforts were not made, but the lack of efforts was appropriate because of a prior judicial finding that the authorized agency was not required to make reasonable efforts to reunify the child(ren) with the parent(s). This determination is based upon the following information [check applicable box(es)]: " Permanency report, sworn to on [specify date]: __________________________________________ " Case record, dated [specify]: ________________________________________________________ " Service plan, dated [specify]: ________________________________________________________ " Probation Department report, dated [specify]: ___________________________________________ " Mental health evaluation, dated [specify]: ______________________________________________ " The report of [specify]: ____________________________ , dated: _____________________________ " Testimony of [specify]: ____________________________, (on _______________________________) " Other [specify]: ______________________________________________________________ Findings and Orders THE COURT ORDERS that: " PLACEMENT OR TEMPORARY REMOVAL IS TERMINATED: " And the child(ren) (is) (are) discharged to the custody of the respondent(s) ______________________ " Immediately or on [specify date]: ______________________________ " without supervision " with supervision of a child protective agency, social services official, or duly authorized agency until:________________ " upon the following terms and conditions: ________________________________________ ______________________________________________________________________________ " THE CHILD(REN) IS/ARE PLACED OR CONTINUE(S) TO BE PLACED in the custody of the Commissioner of Social Services until the completion of the next permanency hearing or pending further orders of this court. The Court finds that continued placement or temporary removal of the child(ren) is required due to best interests and safety needs of the child(ren) and that the child(ren) would be at risk of further abuse or neglect if returned to the parent/respondent. American LegalNet, Inc. www.FormsWorkFlow.com PH-5 Page 3 " [Applicable if placement is for residence with a relative or other suitable person]: And the child(ren) shall reside with [specify relative or other suitable person ]2:____________________ " And during the period of such placement, respondent(s)[specify]: _________________________ shall remain under the supervision of a child protective agency, social services official, or duly authorized agency " upon the following terms and conditions:____________________________________ ________________________________________________________________________ " THE CHILD(REN) IS/ARE DIRECTLY PLACED OR CONTINUE(S) TO BE DIRECTLY PLACED pursuant to Family Court Act §1055(a)(ii), with [specify relative or suitable person]:_____________________ until the completion of the next permanency hearing or further orders of this court. The Court finds that continued placement or temporary removal of the child(ren) is required due to best interests and safety needs of the child(ren) and that the child(ren) would be at risk of further abuse or neglect if returned to the parent/respondent. " THE CHILD(REN) IS/ARE RELEASED, pursuant to Family Court Act §1054, to [specify nonrespondent parent, legal custodian3 or guardian]:_____________________ until [specify date]:4 or further orders of this court. ORDERED that, during the period of release, the individual to whom the child has been released under this Order may [check applicable box(es)]: enroll the child in public school in