F.C.A. §355.3, 355.5 Form 3-38 (Juvenile Delinquency -Petition for Extension of Placement and Permanency Hearing) 12/2015 FAMILY COURT OF THE STATE OF NEW YORK COUNTY OF In the Matter of A Person Alleged to be a Juvenile Delinquent, Respondent. Docket No. Petition (Extension of Placement And Permanency Hearing) DEADLINES: THIS PETITION MUST BE FILED BY [Specify date]:1 AND THE PERMANENCY HEARING MUST BE COMPLETED BY [Specify date]: TO THE FAMILY COURT: The undersigned Petitioner respectfully alleges upon information and belief that: 1. Petitioner [Specify name and title]: , is the [specify]: person official acting on behalf of the [check applicable box]: Commissioner of the N.Y.S. Office of Children and Family Services, Commissioner of Social Services of [specify]: County, Commissioner of the N.Y.C. Administration for Children's Services with whom the Respondent in the above-entitled proceeding has been placed pursuant to section 353.3 of the Family Court Act. Petitioner's residence principal office is located at [specify address ]: , New York. 2. a. Under the Order of Disposition of this Court, dated [specify]: , the above-named Respondent, born , was adjudicated to be a juvenile delinquent within the meaning of Article 3 of the Family Court Act, and was placed with Petitioner for a period of months, terminating on . A copy of the order is annexed as Exhibit A. The petition must be filed at least 60 days prior to the date by which the hearing must be completed. The date should conform to the deadline indicated on the prior Permanency Order, if any, or on the dispositional order. The petition must be served upon all parties to the action, including the attorney for the child, as well as any foster parent or relative providing care to the Respondent and any prospective adoptive parent(s). See F.C.A. §355.5. 1 American LegalNet, Inc. www.FormsWorkFlow.com Form 3-38 Page 2 b. [Delete if inapplicable]: Placement was last extended on [specify date]: , terminating on [specify date]: c. A permanency hearing is required at this time because [check applicable box(es)]: The last permanency hearing was held regarding this placement on [specify date]: No prior permanency hearing has been held. A finding by the Court pursuant to F.C.A. §352.2(2)(c) that reasonable efforts to reunify the Respondent with his or her parent(s) or person(s) legally responsible are not necessary was made on [specify date]: 3. Respondent is now in the care and custody of Petitioner and is residing in a [specify]:2 non-secure facility or foster care program limited secure facility secure facility. 4. a. The following are the names and addresses of the parent(s) or other persons legally responsible for the care of the Respondent or with whom the Respondent resides: Name Residence Relationship b. In addition to the Respondent's parent(s) or or other persons legally responsible for the Respondent's care, the following individuals must be notified of this proceeding: Attorney for the child [specify]: Prospective adoptive parent(s)[specify]: Foster parent(s)[specify]: Relative(s)[specify]: Other [specify]: 5. Continued placement is in the Respondent's best interests and it would not be in the Respondent's best interests to return home because [specify reasons, including safety considerations, if any]: This conclusion is supported by the following information [check applicable box(es)]: Probation Department report, dated [specify]: Mental health evaluation, dated [specify]: Uniform Case Record, dated [specify]: Risk Assessment Instrument Summary of the Uniform Case Record, dated [specify]: Service Plan, dated [specify]: 2 Family Court Act §355.5 requires a permanency hearing only regarding a juvenile who is placed in a non-secure facility, although all juveniles placed pursuant to Family Court Act §353.3 are subject to extensions of placement. See F.C.A. §355.3, 355.5. American LegalNet, Inc. www.FormsWorkFlow.com Form 3-38 Page 3 The report of [specify]: Testimony of [specify]: Other [specify]: , dated [specify]: The permanency plan for the Respondent is as follows [check applicable box(es) and indicate time frame(s)]: reunification with the parent(s) person(s) legally responsible for Respondent's care by [specify date]: placement for adoption upon filing of a petition to terminate parental rights by [specify date]: referral for legal guardianship by [specify name and date]: permanent placement with the following fit and willing relative [specify name]: by [specify date]: . [Applicable ONLY to Respondents who are 16 years of age or older]: permanent placement in the following alternative planned permanent living arrangement (APPLA) [specify]: 6. a. [REQUIRED in all APPLA plan cases]:3 (i) Documentation, made available to the Court, provides the following compelling reason(s) indicating that it would not be in the Respondent's best interests to return home, be referred for termination of parental rights and adoption, placed with a fit and willing relative, or placed with a legal guardian [specify compelling reason(s), indicating documentary sources of information, if any]: (ii) APPLA is the best permanency plan for the Respondent because [specify]: (iii). The following intensive, ongoing, and, as of the date of this petition, unsuccessful efforts were made to return the Respondent home or secure a placement for the Respondent with a fit and willing relative, including adult siblings, a legal guardian, or an adoptive parent, including through efforts that utilize search technology including social media to find biological family members of Respondent [specify]: (iv) The following individual, with whom Respondent has a significant connection, is willing and should be designated as the Respondent's permanency resource [specify]: Although applicable to all youth in care, the requirement for documentation regarding subparagraphs (v) and (vi) to be submitted to the Court applies only to youth with APPLA goals. 3 American LegalNet, Inc. www.FormsWorkFlow.com Form 3-38 Page 4 (v). The "reasonable and prudent parent" standard of care has been applied to Respondent in the facility or home in which he or she resides as follows [specify]: (vi). Respondent has been provided with regular, ongoing opportunities to engage in age or developmentally appropriate activities and has been consulted in an age-appropriate manner about the opportunities to participate in activities as follows [specify]: b. The permanency plan [check applicabl