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JV-290-INFO

INSTRUCTION SHEET FOR CAREGIVER INFORMATION FORM Background
1. What is the "Caregiver Information Form"? The Caregiver Information Form, also called form JV-290, is intended to provide an easily accessible way for foster parents, relative caregivers, preadoptive parents, nonrelative extended family members, legal guardians, community care facilities, and foster family agencies (or any other individual or agency currently caring for a foster child) to provide information about the child to the court. When does it need to be filled out and filed? The Caregiver Information Form is an optional form. If you choose to use it, fill it out and file it with the court along with eight copies, at least five days before the hearing, or mail it to the court for filing at least seven days before the hearing. Follow the instructions below. Do not wait until the day of the court hearing to file the form. Current foster parents, relative caregivers, preadoptive parents, nonrelative extended family members, legal guardians, and other individuals caring for a child: You may fill out this form even if a staff person from the child's foster family agency or community care facility is also filling it out. You may write a letter to the court, instead of using the form. Either way, follow the procedures described on the next page about making copies, filing, and attending the hearing. Be aware that the form or letter will be provided to parties and attorneys. If you are a confidential foster parent, provide information to the child's social worker rather than filing the form or letter with the court. Foster family agencies or community care facilities: You may complete this form and use it as the mandatory report required by Welfare and Institutions Code section 366.21. It is recommended that each agency or facility develop a policy about who is responsible for filling out and filing the form or report on behalf of each child. What should I be thinking about as I fill out the form? Use the form to provide factual information about the child, such as behavior you have observed and information about the child's needs. Avoid including opinions or information not related to the child. The goal is to provide information to the court that helps the judge make informed decisions about the child.

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How to Fill Out Form JV-290
1. Complete the caption. These are the boxes at the top of the page. · Court name, street address, and mailing address. Write the name of the county where the court is located and the street and mailing addresses of the court. If you do not know the name and address of the court, look on the notice of the court hearing you received in the mail or go to www.courtinfo.ca.gov/courts/find.htm to find the local court in your county. For branch name, write "Juvenile." Child's Name. Write the child's first and last names. Hearing Date and Time. Write the hearing date and time. Ask the social worker if you do not have this information. Case Number. This number is on the notice of the court hearing you received in the mail. If you do not have the number, ask the child's social worker or attorney for the number. If the case involves brothers and sisters (siblings), there may be more than one case number. Be sure to use a separate form and the correct number for each child.

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Complete information about the child and about yourself or your agency. · · Item 1. Fill in the child's first and last names, date of birth, and age. Item 2. Foster parents, relative caregivers, and other individuals caring for children should complete item 2. Include your name, what type of caregiver you are, and how many years and/or months the child has lived in your home. Skip item 3. If you are a confidential foster parent, provide information to the child's social worker rather than filing this form with the court. Item 3. Foster family agencies, community care facilities, and staff at any other group-care setting should skip Item 2 and complete item 3. Indicate the facility name, address, telephone number, the type of facility, how long the child has been with your agency, and how long he or she has been in the current placement. Then write your name (the person completing form) and your title. If it is not clear from your title, explain in what capacity you work with the child. Indicate how many hours each week you spend with the child. Finally, check the box to indicate whether you are filling out the form based on your own observations and recommendations or on those of a group or team. If applicable, specify the members of the group or team.
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Form Approved for Optional Use Judicial Council of California JV-290-INFO [New October 1, 2007]

INSTRUCTION SHEET FOR CAREGIVER INFORMATION FORM

Welfare and Institutions Code, §§ 366.21; 16010(f)(3); Cal. Rules of Court, rule 5.534(m) www.courtinfo.ca.gov

JV-290-INFO 3. Complete items 4­10 about the child. For each question, check the box to indicate whether there is new information since the last hearing. Briefly write new information in the appropriate section of the form. Do not describe anything you have not personally observed. · · · · Item 4. Provide information on the child's medical, dental, and general physical and emotional health (e.g., doctor visits, hospitalizations, and medications; descriptions of physical or emotional development). Item 5. Provide information on the child's status at school, if applicable (e.g., child's grade level; public or nonpublic school; how the child is doing in school; outcomes of testing or school conferences). Item 6. Indicate whether the child is a special education student and, if so, the date of the most recent Individualized Education Plan (IEP). Item 7. Provide information on how the child is adjusting to your home/facility (e.g., child's social skills and behavior at home; how the child is interacting with other family members; how the child expresses feelings and needs; the child's eating and sleeping patterns). Item 8. Provide information on how the child is getting along with others (e.g., peer relationships, relationships with teachers and other adults outside of your family). Item 9. Provide information on the child's special interests and activities (e.g., participation in sports or music lessons; how often the child participates; any talents, interests, or hobbies). Item 10. Provide any additional information that you believe the court should know about the child (e.g., behavioral information; services the child is receiving; your recommendations for additional services that are needed; visitation information, such as dates of visits with parents or siblings).

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Recommendation for Disposition (Outcome). If you are a community care facility or foster family agency, you must include your recommendation for disposition if the JV-290 form is being used as your report required under Welfare and Institutions Code section 366.21(d). Foster parents and other individual caregivers may include their recommendation for disposition (outcome) if they choose. Add any attachments. Check the box in item 12 to add additional pages. You may attach information from the child's teacher, doctor, or other service providers and a photograph of the child. Sign and date the form. On the bottom of page 2, write the date, type or print your name, and sign your name.

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What to Do With the Form After You Have Filled It Out
1. 2. Make copies. Caregivers should make eight or more copies of the completed JV-290 form and any attachments. If you choose to file the form in person. At least five calendar days before the hearing date, bring the original form and the recommended eight copies to the court clerk's office at the courthouse where the hearing will be held. Ask the clerk to file the form for you. Keep one copy of the date-stamped form for yourself. The clerk is responsible for providing the form to all parties and completing and filing the proof of service form. If you choose to file the form by mail. At least seven calendar days before the hearing date, mail the original form and all but one of the copies to the court clerk's office at the courthouse where the hearing will be held. Put two stamps on the envelope. Include a note indicating "For filing and service" and including the case number. The clerk is responsible for providing the form to all parties and completing and filing the proof of service form. Confirm the hearing time, date, and place. If you plan to attend the hearing, call the social worker to confirm the hearing date, time, and courtroom.

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What to Do on the Hearing Day
1. 2. Bring extra copies of the form. If you decide to attend the hearing, it is suggested that you make additional copies of the form and any attachments in order to provide copies to anyone at the hearing who did not receive them. Comments in court. If you choose to attend the hearing, any comments you make should be short, factual, and based on your own observations. You may raise your hand to let the judge know you would like to speak, or let the courtroom clerk or deputy/bailiff know before the hearing.

JV-290-INFO [New October 1, 2007]

INSTRUCTION SHEET FOR CAREGIVER INFORMATION FORM

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