Purpose of SFN 904 624-05-30-15-05

(Revised 1/15/21 ML #3606)

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The agreement to furnish specialized family foster care services as a foster care excess maintenance payment, SFN 904 must be completed before a specialized foster care payment can be made to the family foster care provider. The form is initiated after a need for an excess maintenance payment (623-05-30-30) is determined.

 

The dollar amount or level to be paid is determined based on the evaluation score from the SFN 1865. Payments identified on the SFN 904 must be reviewed at quarterly Child and Family Team meetings and cannot exceed six months in duration or the end of the primary placement, whichever comes first.

 

Signatures are required on the SFN 904 from the foster parent, custodial agency foster care case manager, and the assigned Field Service Specialist. Copies of the signed SFN 904 must be distributed accordingly.