Cal. Code Regs. Tit. 22, § 35001 - Definitions-Forms

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The following forms, which are incorporated by reference, apply to the regulations in Title 22, Division 2, Subdivision 4, Chapter 3 (Adoption Program Regulations).

(a)

(1) "AAP 1" (9/09) means the form entitled, "Request for Adoption Assistance Program Benefit."

(2) "AAP 2" (7/11) means the form entitled, "Payment Instructions -- Adoption Assistance Program."

(3) "AAP 3" (7/11) means the form entitled, "Reassessment Information -- Adoption Assistance Program."

(4) "AAP 4" (11/11) means the form entitled, "Eligibility Certification -- Adoption Assistance Program."

(5) "AAP 6" (11/11) means the form entitled, "Adoption Assistance Program -- Negotiated Benefit Amount and Approval and Form Instructions."

(6) "AAP 8" (11/11) means the form entitled, "Adoption Assistance Program -- Nonrecurring Adoption Expenses Agreement."

(7) "AD 1A" (4/15) means the form entitled, "Parental Consent to Adoption (In or Out-of-California)."

(8) "AD 1F" (4/15) means the form entitled, "Parental Consent to Adoption (Outside California in the Armed Forces)."

(9) "AD 8" (10/01) means the form entitled, "Marriage/Divorce Verification."

(10) "AD 9" (11/07) means the form entitled, "Independent Adoption Questionnaire."

(11) "AD 10" (9/03) means the form entitled, "Request for Reference."

(12) "AD 20" (4/15) means the form entitled, "Refusal to Give Parental Consent to Adoption (Birth Mother/Presumed/Biological Father/Legal Parent)."

(13) "AD 20B" (5/15) means the form entitled, "Refusal to Give Parental Consent to Adoption--Alleged Father."

(14) "AD 42 I" (3/02) means the form entitled, "Independent Adoption Program -- Individual Case Report."

(15) "AD 42R" (7/95) means the form entitled, "Relinquishment Adoption Program -- Individual Case Report."

(16) "AD 65" (2/02) means the form entitled, "Parent's Authorization for Medical and Surgical Care."

(17) "AD 67" (5/15) means the form entitled, "Information About the Birth Mother."

(18) "AD 67A" (7/15) means the form entitled, "Information About the Birth Father."

(19) "AD 90" (6/13) means the form entitled, "Supporting Information for Issuance of California Department of Social Services Acknowledgment and Confirmation of Receipt of Child Freeing Documents."

(20) "AD 100" (7/10) means the form entitled, "Authorization for Use and/or Disclosure of Information Independent Adoption Program."

(21) "AD 100A" (7/20) means the form entitled, "Authorized for Release, Use and/or Disclosure of Health Information Agency Adoption Program."

(22) "AD 165" (3/15) means the form entitled, "Presumed Father's Consent to Adoption When Denying He is the Biological Father (In or Out-of-California)."

(23) "AD 501 ENG/SP" (12/91) means the form entitled, "Relinquishment (Birth Mother and/or Presumed Father)."

(24) "AD 501A ENG/SP" (12/91) means the form entitled, "Relinquishment (Out of State)."

(25) "AD 503 ENG/SP" (12/91) means the form entitled, "Relinquishment -- Out of County (Birth Mother and/or Presumed Father)."

(26) "AD 504 ENG/SP" (12/91) means the form entitled, "Relinquishment -- Out of State -- in-Armed Forces."

(27) "AD 508 ENG/SP" (3/82) means the form entitled, Rescission Request/Rescission of Relinquishment."

(28) "AD 512" (1/14) means the form entitled, "Psychosocial and Medical History of Child."

(29) "AD 551A" (3/94) means the form entitled, "Notification of Procedure in Lieu of Signing Relinquishment Waiver or Denial."

(30) "AD 558" (8/97) means the form entitled, "Notice of Placement."

(31) "AD 580" (6/97) means the form entitled, "Notice of Removal of Child from Adoptive Home."

(32) "AD 583 Eng/Sp" (6/95) means the form entitled, "Relinquishment -- Out of County (Presumed Father Denies He is the Birth Father)."

(33) "AD 584 Eng/Sp" (8/95) means the form entitled, "Relinquishment -- Out of State (Presumed Father Denies He is the Birth Father)."

(34) "AD 586 Eng/Sp" (6/97) means the form entitled, "Relinquishment -- In or Out of County (Alleged Natural Father in California)."

(35) "AD 588" (4/15) means the form entitled, "Denial of Paternity by Alleged Father -- (In or Out-of-California)."

(36) "AD 590" (4/15) means the form entitled, "Waiver of Right to Further Notice of Adoption Planning (Alleged Father In or Out-of-California)."

(37) "AD 591 Eng/Sp" (12/91) means the form entitled, "Relinquishment (Alleged Natural Father) Out of State or County."

(38) "AD 593" (12/91) means the form entitled, "Relinquishment (Alleged Natural Father) Outside of California in Armed Forces."

(39) "AD 594" (3/15) means the form entitled, "Alleged Father's Consent to Adoption (In or Out-of-California)."

(40) "AD 824" (5/97) means the form entitled, "Consent and Joinder" for agency adoptions.

(41) "AD 830" (9/97) means the form entitled, "Summary Claim for Reimbursement Private Adoption Agency Reimbursement Program."

(42) "AD 842" (3/17) means the form entitled, "Alleged Father's Consent to Adoption (Outside California in the Armed Forces)."

(43) "AD 859" (8/15) means the form entitled, "Parental Consent to Adoption of Indian Child (In or Out-of-California)."

(44) "AD 860" (8/15) means the form entitled, "Presumed Father's Consent to Adoption of Indian Child (In or Out-of-California)."

(45) "AD 861" (8/15) means the form entitled, "Alleged Father's Consent to Adoption of Indian Child (In or Out-of-California)."

(46) "AD 862" (12/91) means the form entitled, "Relinquishment of Indian Child by Alleged Natural Father -- Out of State or County."

(47) "AD 863" (12/91) means the form entitled, "Relinquishment of Indian Child -- Out of State."

(48) "AD 864" (1/92) means the form entitled, "Relinquishment of Indian Child (Birth Mother and/or Presumed Father)."

(49) "AD 866" (8/95) means the form entitled, "Relinquishment of Indian Child (Presumed Father Denies He is the Birth Father)."

(50) "AD 867" (6/95) means the form entitled, "Relinquishment of Indian Child (Presumed Father Denies He is the Birth Father) Out of State."

(51) "AD 868" (1/92) means the form entitled, "Relinquishment of Indian Child (Alleged Natural Father in California) In/Out of County."

(52) "AD 880" (9/15) means the form entitled, "Declaration of Mother."

(53) "AD 885" (7/98) means the form entitled, "Statement of Understanding -- Agency Adoptions Program (Mother or a Presumed Father of the Child Who Is Not Detained, a Juvenile Court Dependent in Out-of-Home Care, or the Ward of a Legal Guardian)."

(54) "AD 885A" (9/98) means the form entitled, "Statement of Understanding -- Agency Adoptions Program (Mother or a Presumed Father of a Child Who Is Detained, a Juvenile Court Dependent in Out-of-Home Care, or the Ward of a Legal Guardian)."

(55) "AD 885C" (7/98) means the form entitled, "Statement of Understanding -- Agency Adoptions Program (Alleged Natural Father of the Child Who Is Not Detained, a Juvenile Court Dependent in Out-of-Home Care, or the Ward of a Legal Guardian)."

(56) "AD 885D" (7/98) means the form entitled, "Statement of Understanding -- Agency Adoptions Program (Alleged Natural Father of the Child Who Is Detained, a Juvenile Court Dependent in Out-of-Home Care, or the Ward of a Legal Guardian)."

(57) "AD 887" (3/18) means the form entitled, "Statement of Understanding -- Independent Adoptions Program Parent Who Gave Physical Custody (Custodial Parent) of the Child to the Petitioner(s))."

(58) "AD 887A" (3/18) means the form entitled, "Statement of Understanding -- Independent Adoptions Program (Parent Who Did Not Give Physical Custody (Non-Custodial Parent) of the Child to the Petitioner(s))."

(59) "AD 887B" (3/18) means the form entitled, "Statement of Understanding -- Independent Adoptions Program (Alleged Father)."

(60) "AD 898" (1/11) means the form entitled, "Consent of California Department of Social Services or Delegated County Adoption Agency -- Independent Adoptions Program."

(61) "AD 899" (7/98) means the form entitled, "Statement of Understanding -- Agency Adoptions Program (Mother or a Presumed Father of the Indian Child Who Is Not Detained, a Juvenile Court Dependent in Out-of-Home Care, or the Ward of a Legal Guardian)."

(62) "AD 899A" (7/98) means the form entitled, "Statement of Understanding -- Agency Adoptions Program (Mother or a Presumed Father of an Indian Child Who Is Not Detained, a Juvenile Court Dependent in Out-of-Home Care, or the Ward of a Legal Guardian)."

(63) "AD 899C" (7/98) means the form entitled, "Statement of Understanding -- Agency Adoptions Program (Alleged Natural Father of the Indian Child Who Is Not Detained, a Juvenile Court Dependent in Out-of-Home Care, or the Ward of a Legal Guardian)."

(64) "AD 899D" (7/98) means the form entitled, "Statement of Understanding -- Agency Adoptions Program (Alleged Natural Father of the Indian Child Who Is Not Detained, a Juvenile Court Dependent in Out-of-Home Care, or the Ward of a Legal Guardian)."

(65) "AD 900" (8/18) means the form entitled, "Statement of Understanding -- Independent Adoptions Program (Parent Who Gave Physical Custody (Custodial Parent) of the Indian Child to the Petitioner(s))."

(66) "AD 900A" (3/18) means the form entitled, "Statement of Understanding -- Independent Adoptions Program (Parent Who Did Not Give Physical Custody (Non-Custodial Parent) of the Indian Child to the Petitioner(s))."

(67) "AD 900B" (3/18) means the form entitled, "Statement of Understanding -- Independent Adoptions Program (Alleged Father of Indian Child)."

(68) "AD 904" (7/11) means the form entitled, "Consent for Contact."

(69) "AD 904A" (12/10) means the form entitled, "Waiver of Rights to Confidentiality for Siblings."

(70) "AD 904B" (1/11) means the form entitled, "Waiver of Rights to Confidentiality for Siblings -- Under the Age of 18."

(71) "AD 907" (5/94) means the form entitled, "Adoptive Placement Agreement."

(72) "AD 908" (9/15) means the form entitled, "Adoptions Information Act Statement."

(73) "AD 908A" (1/11) means the form entitled, "Adoptions Information Act Statement (Adult Adoptee (age 21 or older))."

(74) "AD 909" (8/88) means the form entitled, "Photolisting Data Sheet."

(75) "AD 924" (5/15) means the form entitled, "Independent Adoption Placement Agreement."

(76) "AD 925" (8/15) means the form entitled, "Independent Adoption Placement Agreement -- (Indian Child)."

(77) "AD 926" (1/18) means the form entitled, "Statement of Understanding -- Independent Adoption Program (Parent Who Places the Child with the Prospective Adoptive Parent(s))."

(78) "AD 927" (3/18) means the form entitled, "Statement of Understanding -- Independent Adoption Program (Parent Who Places the Indian Child with the Prospective Adoptive Parent(s))."

(79) "AD 928" (7/02) means the form entitled, "Revocation of Consent -- Independent Adoption Program."

(80) "AD 929" (9/18) means the form entitled, "Waiver of Right to Revoke Consent -- Independent Adoption Program."

(81) "AD 929A" (4/21) means the form entitled, "Waiver of Right to Revoke Relinquishment -- Agency Adoption Program."

(82) "AD 930" (7/11) means the form entitled, "Independent Adoption Placement Agreement Transmittal."

(83) "AD 4310" (1/93) means the form entitled, "Adoption Programs Notice Required by Information Practices Act."

(84) "AD 4317" (3/82) means the form entitled, "Revocation of Relinquishment."

(85) "AD 4320" (11/11) means the form entitled, "Adoption Assistance Program Agreement."

(86) "AD 4333" (8/14) means the form entitled, "Acknowledgement or Confirmation of Receipt of Child Freeing Documents."

(87) "AD 4336" (4/15) means the form entitled, "Presumed Father's Consent to Adoption When Denying He is the Biological Father (Outside of California in the Armed Forces)."

(88) "ADM 36" (6/99) means the form entitled, "Medical Report Regarding Child to be Adopted."

(b)

(1) "BCIA 8016" (1/2011) means the form entitled, "Request for Live Scan Service."

(2) "BCIA 8302" (8/2016) means the form entitled, "No Longer Interested (NLI) Notification (For Non-Department of Justice Applicants)."

(3) "BCII 9004" (3/05) means the form entitled, "Request for Exemption from Mandatory Electronic Fingerprint Submission Requirement."

(d) Reserved

(e) Reserved

(f)

(1) "FC 3" (11/04) means the form entitled, "Determination of Federal AFDC-FC Eligibility."

(2) "FC 8" (7/11) means the form entitled, "Federal Eligibility Certification for Adoption Assistance Program."

(3) "FC 10" (8/09) means the form entitled, "Income and Property Checklist for Federal Eligibility Determination -- Adoption Assistance Program."

(4) "FD 258" (9/9/13) means the fingerprint card.

(g) Reserved

(h) Reserved

(i)

(1) "ICPC 100A" (8/2001) means the form entitled, "Interstate Compact On The Placement Of Children Request."

(2) "ICPC 100B" (8/2001) means the form entitled, "Interstate Compact On The Placement of Children Report on Child's Placement Status."

(3) "I-600" (02/01/15) means the form entitled, "Petition to Classify Orphan as an Immediate Relative."

(j) Judicial Council Forms to Finalize Adoptions

(1) "Adopt-200" (Revised January 1, 2018) means the form entitled, "Adoption Request."

(2) "Adopt-210" (Revised January 1, 2016) means the form entitled, "Adoption Agreement."

(3) "Adopt-215 (Revised January 1, 2016) means the form entitled, "Adoption Order."

(4) "Adopt-220" (Revised July 1, 2010) means the form entitled, "Adoption of Indian Child."

(5) "Adopt-225" (Revised January 1, 2005) means the form entitled, "Parent of Indian Child Agrees to End Parental Rights."

(6) "Adopt-230" (Revised January 1, 2007) means the form entitled, "Adoption Expenses."

(7) "Adopt-310" (Revised January 1, 2018) means the form entitled, "Contact After Adoption Agreement."

(8) "ICWA-010(A)" (New January 1, 2008) means the form entitled, "Indian Child Inquiry Attachment."

(9) "ICWA-020" (New January 1, 2008) means the form entitled, "Parental Notification of Indian Status."

(10) "ICWA-030" (New January 1, 2008) means the form entitled, "Notice of Child Custody Proceeding for Indian Child."

(11) "ICWA-030(A) (New January 1, 2008) means the form entitled, "Attachment to Notice of Child Custody Proceeding for Indian Child."

(12) "JV-505" ( Revised January 1, 2008) means the form entitled, "Statement Regarding Parentage (Juvenile)."

(k) Reserved

(l)

(1) "LIC 9163" (12/15) means the form entitled, "Request for Live Scan Service--Community Care Licensing."

(m)-(u) Reserved

(v)

(1) "VS 44" (Rev. 1/16) means the form entitled, "Court Report of Adoption."

(w)-(z) Reserved

Notes

Cal. Code Regs. Tit. 22, § 35001

Note: Authority cited: Sections 10553, 10554, 16118 and 16120, Welfare and Institutions Code; and Sections 8608, 8619, 8621 and 8901, Family Code. Reference: Sections 16105, 16118 and 16120.05, Welfare and Institutions Code; Sections 7660.5, 7663, 7667, 8500 et seq., 8600 et seq., 8700 et seq., 8800 et seq., 8900 et seq., 9100 et seq. and 9200 et seq., Family Code; Section 1283, Health and Safety Code; Sections 1183 and 1183.5, Civil Code; and California Rules of Court, rules 5.481 and 5.482.

1. Renumbering of former section 35001 to section 35002 and new section filed 9-8-93; operative 10-7-93 (Register 93, No. 37). For prior history, see Register 91, No. 52.
2. New subsections (a)(1)-(4) and subsection renumbering, new subsection (a)(48), reservation of subsections (b)-(f)(2), new subsection (f)(3), reservation of subsections (f)(4)-(7), new subsections (f)(8)-(10) and amendment of Note filed 10-31-94 as an emergency; operative 11-1-94 (Register 94, No. 44). A Certificate of Compliance must be transmitted to OAL by 3-1-95 or emergency language will be repealed by operation of law on the following day.
3. New subsections (a)(5)-(9), (a)(12), (a)(14)-(15), (a)(20), (a)(23)-(25), (a)(34)-(40), (a)(49), (a)(64)-(65), (a)(69)-(78) and (b)-(z), subsection renumbering, amendment of redesignated subsections (a)(13), (a)(54)-(56), (a)(61)-(63), repealer of subsection (a)(44), and amendment of Note filed 12-29-94; operative 1-1-95 (Register 94, No. 52).
4. Editorial correction of subsection renumbering (Register 95, No. 6).
5. Editorial correction of History 3 and inserting inadvertently omitted History 4 (Register 95, No. 13).
6. Change without regulatory effect adding new subsection (a)(80) filed 3-27-95 pursuant to section 100, title 1, California Code of Regulations (Register 95, No. 13).
7. Certificate of Compliance as to 10-31-94 order including amendment of section transmitted to OAL 2-27-95 and filed 4-10-95 (Register 95, No. 15).
8. Amendment filed 7-30-98 as an emergency; operative 8-1-98 (Register 98, No. 31). A Certificate of Compliance must be transmitted to OAL by 11-30-98 or emergency language will be repealed by operation of law on the following day.
9. Amendment refiled 11-24-98 as an emergency; operative 11-29-98 (Register 98, No. 48). A Certificate of Compliance must be transmitted to OAL by 3-29-99 or emergency language will be repealed by operation of law on the following day.
10. Certificate of Compliance as to 11-24-98 order, including amendment of section, transmitted to OAL 3-25-99 and filed 5-3-99 (Register 99, No. 19).
11. Amendment of subsections (a)(1), (a)(3) and (a)(85) filed 11-30-2000 as an emergency; operative 12-1-2000 (Register 2001, No. 13). A Certificate of Compliance must be transmitted to OAL by 3-30-2001 or emergency language will be repealed by operation of law on the following day.
12. Amendment of subsections (a)(1), (a)(3) and (a)(85) refiled 3-30-2001 as an emergency; operative 3-31-2001 (Register 2001, No. 13). A Certificate of Compliance must be transmitted to OAL by 7-30-2001 or emergency language will be repealed by operation of law on the following day.
13. Certificate of Compliance as to 3-31-2001 order, including further amendment of subsections (a)(1), (a)(3) and (a)(85), transmitted to OAL 7-27-2001 and filed 9-6-2001 (Register 2001, No. 36).
14. Amendment of subsections (a)(1)-(4), new subsections (a)(5)-(6), subsection renumbering and amendment of newly designated subsection (a)(87) and subsections (f)(8) and (f)(10) filed 11-10-2011; operative 12-10-2011 (Register 2011, No. 45).
15. Amendment of subsection (j)(6) filed 1-15-2019; operative 4-1-2019 (Register 2019, No. 3).
16. Amendment of section and Note filed 1-13-2021; operative 4/1/2021 (Register 2021, No. 3). (Filing deadline specified in Government Code section 11349.3(a) extended 60 calendar days pursuant to Executive Order N-40-20.)
17. New subsection (a)(85) and subsection renumbering filed 10-31-2022; operative 1/1/2023 (Register 2022, No. 44).
18. Editorial correction reinstating definitions in subsections (a)(86)-(89) and (a)(91)-(93) (Register 2024, No. 18).
19. Change without regulatory effect repealing subsections (a)(19)-(22) and (a)(92) and renumbering subsections filed 5-2-2024 pursuant to section 100, title 1, California Code of Regulations (Register 2024, No. 18).

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