JV-567 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address): FOR COURT USE ONLY TELEPHONE NO.: E-MAIL ADDRESS (Optional): ATTORNEY FOR (Name): FAX NO. (Optional): SUPERIOR COURT OF CALIFORNIA, COUNTY OF STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME: CASE NAME: EXPEDITED PLACEMENT UNDER THE INTERSTATE COMPACT ON THE PLACEMENT OF CHILDREN: FINDINGS AND ORDERS CASE NUMBER: 1. This matter came before the court for the issuance of an order for an expedited placement decision under Regulation No. 7 of the Interstate Compact on the Placement of Children (ICPC) on a. Hearing Date: Time: Dept.: Room: b. Judicial Officer: c. Court Telephone No.: d. Court Fax No.: e. Court E-mail: 2. Child's name: Child's date of birth: 3. The court has read and considered and admits into evidence a. b. Signed statement of interest from the potential placement or statement from the social worker regarding the appropriateness of the potential placement, as required by Regulation No. 7, section 7(a) (statement date): Statement from the child welfare agency that it is unaware of any fact that would prohibit the child from being placed with the potential placement and that it has completed, and is prepared to send, all required paperwork to the county ICPC Liaison, as required by Regulation No. 7, section 7(b) (statement date): Report of social worker, dated: Report of CASA volunteer, dated: Case plan, dated: Other: c. d. e. f. BASED ON THE EVIDENCE LISTED ABOVE AND ALL OTHER EVIDENCE BEFORE THE COURT, THE COURT FINDS AND ORDERS 4. These findings are made by a preponderance of the evidence. 5. The child for whom out-of-state placement is sought is the child named in item 2. The child is a dependent child within the jurisdiction of this court, based on a petition filed by the child welfare agency. The child does not currently live in the home of the parent or guardian from whom the child was removed. 6. The court has the authority to determine custody and placement of the child or has delegated that authority to the child welfare agency. 7. Sections 5, 6, and 7 of Regulation No. 7 of the ICPC apply to the child. Page 1 of 4 Form Adopted for Mandatory Use Judicial Council of California JV-567 [Rev. January 1, 2013] EXPEDITED PLACEMENT UNDER THE INTERSTATE COMPACT ON THE PLACEMENT OF CHILDREN: FINDINGS AND ORDERS Family Code, § 7900 et seq.; Cal. Rules of Court, rule 5.616; ICPC Regulation No. 7 www.courts.ca.gov American LegalNet, Inc. www.FormsWorkFlow.com JV-567 CASE NAME: CASE NUMBER: 8. The proposed placement for the child in the receiving state is the home of the child's a. b. c. Stepparent Adult brother or sister Guardian d. e. f. Grandparent Adult uncle or aunt Other (specify): Proposed placement (name): Located at (address): 9. Based on the facts stated in the record, the court finds that the child meets the following expedited placement criteria (check one or more): a. Unexpected dependency due to one of the following: (1) (2) (3) b. c. Sudden or recent incarceration of a parent or guardian; Incapacitation of a parent or guardian, defined as a parent or guardian who is unable to care for the child because of the parent's or guardian's unexpected medical, mental, or physical condition; or Death of a parent or guardian. The child is 4 years of age or younger. The child is part of a group of siblings who will be placed together, where one or more of the child's siblings is 4 years of age or younger (names and dates of birth of siblings 4 years of age or younger): d. The child has a substantial relationship with the person named as the proposed placement in item 8., above. (Substantial relationship means the person has spent more than cursory time with the child, is known to the child, and has established more than a minimal bond with the child.) One or more of the child's siblings in the sibling group sought to be placed has a substantial relationship with the person named as the proposed placement in item 8., above (name of sibling or siblings): The child is currently in an emergency placement. e. f. 10. The child welfare agency has provided the court with one of the following documents, as required by Regulation No. 7, section 7(a): a. b. A signed statement of interest from the person named as the proposed placement in item 8., confirming that he or she meets each of the Regulation No. 7, section 7(a), requirements; or A signed statement from the assigned California social worker stating that the social worker spoke to the person named as the proposed placement in item 8. and that the person confirmed that he or she meets each of the Regulation No. 7, section 7(a), requirements. 11. The child welfare agency has completed and is prepared to send all required paperwork to the county ICPC Liaison, including the statement regarding the proposed placement and forms ICPC-100A and ICPC-101. Child Welfare Agency Orders 12. The child welfare agency is ordered to be the sending agency in this matter and directed to complete, execute, and file all necessary forms and carry out all obligations and responsibilities as the sending agency under the ICPC. 13. The child welfare agency is ordered to send to the county ICPC Liaison in the sending jurisdiction, within three business days of receipt of this order, completed forms ICPC-100A and ICPC-101, a copy of this order, and, if not already sent, all documentation required for compliance with Regulation No. 7 and any supporting documentation under ICPC article 3. The county ICPC Liaison is ordered to forward all documents to the receiving state's compact administrator within two business days. 14. The child welfare agency is ordered to request a comprehensive home study of the potential placement resource in the receiving state and an expedited placement decision. JV-567 [Rev. January 1, 2013] EXPEDITED PLACEMENT UNDER THE INTERSTATE COMPACT ON THE PLACEMENT OF CHILDREN: FINDINGS AND ORDERS Page 2 of 4 JV-567 CASE NAME: CASE NUMBER: 15. The child welfare agency is ordered to take whatever additional steps are necessary, including follow-up contacts, to ensure that the process is completed in a timely manner so as to protect the best interests of the child. 16. The child welfare agency is ordered to inform this court promptly and regularly of the progress and results of this order. This includes informing this court as soon as possible on learning that the home study has not been completed and sent to California by the receiving st