F.C.A. § 1089 Form PH-6 (Permanency Hearing Order Regarding Child Freed for Adoption) 6/2016 At a term of Family Court of the State of New York, held in and for the County of , at New York on , . PRESENT: Hon. Judge ______________________________ In the Matter of the Permanency Hearing Regarding Docket No. PERMANENCY HEARING ORDER (Permanency Hearing Regarding Child Freed for Adoption) CIN # A Child Under the Age of 21 who Has Been Freed for Adoption THE NEXT PERMANENCY HEARING SHALL BE HELD ON [specify date and time certain within six months of completion of this hearing]: ________________________________ . The report of [specify]: above-named child, sworn to on [specify date]: , for a Permanency Hearing regarding the , having been filed in this Court; And, as indicated below, notice of the permanency hearing and the permanency report having been duly sent to the following person(s) not less than 14 days in advance of the date scheduled for this hearing and the following persons having appeared [specify; check applicable boxes]: " Prospective adoptive parent(s)[specify]: " Foster parent(s)caring for child [specify]: " Relative(s) caring for child [specify]: " Authorized agency caring for child [specify]: " Attorney for the child [specify]: " Former foster parent(s) who cared for the child in excess of one year [specify]: " Other [specify]: [check box(es) if applicable]: " given notice " given notice " given notice " given notice " given notice " appeared " appeared " appeared " appeared " appeared " did not appear " did not appear " did not appear " did not appear " did not appear " did not appear " did not appear " given notice " appeared " given notice " appeared Child: And the following child(ren) having [check applicable box(es)]: " appeared " participated as follows [specify]: American LegalNet, Inc. www.FormsWorkFlow.com Form PH-6 Child: Child: " did not participate " appeared " participated as follows [specify]: " did not participate " appeared " participated as follows [specify]: " did not participate Page 2 And the child(ren) having been represented by an attorney for the child and the Court having consulted with the child(ren) in an age-appropriate manner regarding the proposed permanency plan; " And notice of the permanency hearing having been sent not less than 14 days in advance of the hearing to the following former foster parents, who provided care for the child in excess of one year [specify;]: " And the Court having dispensed with notice to the following former foster care parent(s) [specify]: as contrary to the child's best interests: [Required where adoption is the permanency plan; check box if applicable]: " And the Court having determined that the child has been duly freed for adoption and that adoption is in the child's best interests. And the matter having duly come on to be heard, and the above-named persons appearing having been given an opportunity to be heard; And the Court having considered the position and information provided by the [check applicable box(es)]: " authorized agency " local department of social services; The Court, after having made an examination and inquiry into the facts and circumstances of the case and into the surroundings, conditions, and capacities of the persons involved, finds and determines the following [Note: judicial findings must be made under I and, if applicable, II and III]: I. Required "Reasonable Efforts" Findings [check applicable boxes; provide case-specific reasons]: A. [Findings required where adoption is the permanency plan]: Reasonable efforts to make and finalize the permanency plan of ADOPTION G were made as follows [specify; check applicable box(es)]: : G for child freed for adoption , but not yet placed in pre-adoptive home: G recruitment efforts [specify, including consideration of out-of-State resources]: G other [specify]: G for child freed for adoption and placed in pre-adoptive home G adoption placement agreement signed G adoptive parent(s) retained attorney(s) G adoption subsidy application: Qsubmitted to NYS OCFS and: Qgranted Qdenied Qpending Qre-submitted Qsubmitted and pending review by local dept. of social services or NYC ACS G criminal history checks: Q submitted Q completed G child abuse and maltreatment checks: Q submitted Qcompleted G Interstate Compact on Placement of Children Q submitted Q completed American LegalNet, Inc. www.FormsWorkFlow.com Form PH-6 G home study completed G birth parents' documents submitted: certified copy of: G order terminating parental rights G surrender G consent G death certificate G putative father: G putative father registry request made G other [specify]: G child's documents submitted: G two copies of certified birth certificate G medical report G consent, if child 14 or over G adoptive parents' documents submitted: G financial disclosure affidavit G medical report G marriage certificate, if applicable G divorce certificate, if applicable G death certificate of adoptive spouse, if applicable G back-up resource documents submitted, if applicable [specify]: G attorney's documents submitted: G affidavit of readiness G financial disclosure affidavit G certification of service upon OCA G adoption petition: G docketed G scheduled for hearing on [specify]: G were not made. OR B. [Findings required where permanency plan is other than adoption]: Reasonable efforts to make and finalize the permanency plan of [specify]: G were made as follows [specify including consideration of out-of-State resources]: G were not made. The conclusion in ¶ I A or I B is supported by the following information [check applicable box(es)]: G Permanency Report, sworn to on [specify date]: G Case Record, dated [specify]: G Service Plan, dated [specify]: G The report of [specify]: , dated [specify]: G The testimony of [specify]: G Other [specify]: Page 3 II. Findings: Transitional Services, Out-of-State Placements and Children Over 18: " [Required if child in out-of-home care is or by the next permanency hearing will be 14 years of age or older]: " The following services and assistance are needed to assist the child(ren) in learning independent living skills to make the transition from foster care to successful adulthood [specify]: OR " The Court finds that NO services or assistance are needed to assist the child(ren) to assist the child(ren) in learning independent living skills to make the transition from foster care to successful adulthood. American LegalNet, Inc. www.FormsWorkFlow.com