Children's Administration, Department of Social and Health Services
Children's Administration, Department of Social and Health Services
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Indian Child Welfare Manual


This chapter contains forms that Children’s Administration (CA) staff use to fulfill the requirements of this manual with respect to CA’s Indian child welfare program. The forms are available for downloading through the department’s Forms and Records Section at the following address:

13.05 FORMS

DSHS 04-220(X) Family Ancestry Chart

DSHS 09-428(X) Dependency Petition

DSHS 09-453 Guardianship Petition

DSHS 09-474 Petition for Relinquishment and Termination of Parent Child Relationship (RCW 26.33)

DSHS 09-536 Inquiry to Bureau of Indian Affairs

DSHS 09-537 Notice to Non-Federally Recognized or Canadian First Nations Tribe or Band

DSHS 09-539 Inquiry to Indian Tribe, Band, or Nation Re: Membership Status

DSHS 09-541 Notice to Indian Tribe, Band or Nation

DSHS 09-542 Notice of Intervention and Request for Continuance - Indian Tribe

DSHS 09-543 Notice to Parent/Indian Custodian

DSHS 09-544 Request for Continuance - Parent/Indian Custodian

DSHS 09-545 Notice to BIA

DSHS 09-547 Motion and Order to Transfer Jurisdiction to Tribal Court

DSHS 09-548 Motion and Order for the Tribal Court to Accept Jurisdiction Under 25 U.S.C. 1911(b)

DSHS 09-758 Notice to Child's Tribe of Alternative Residential Placement (ARP) Proceeding

DSHS 09-759 Motion, Declaration, of Child's Return from Voluntary Foster Care Placement, and Order of Dismissal

DSHS 09-760 Notice of Placement Change

DSHS 09-761 Indian Identity Request

DSHS 09-762 Petition for Court Validation of Voluntary Consent to Foster Care Placement of an Indian Child

DSHS 09-763 Consent to Foster Care Placement and Court Certification

DSHS 09-764 Relinquishment of Custody, Consent to Termination/ Adoption, and Court Certification - Indian Child

DSHS 09-765 Declaration of Adoption Facilitator

DSHS 09-766 Petition for Termination of Parent-Child Relationship (RCW 13.34)

DSHS 09-767 Declaration of Notification - Foster Care Placement Validation Hearing

DSHS 09-768 Superior Court Adoption Information for Indian Child

DSHS 09-769 Voluntary Relinquishment and Adoption Information to Parent of Indian Child

DSHS 09-770 Notice and Summons (Relinquishment/ Termination/ Adoption)

DSHS 09-771 Addendum to Petition

DSHS 09-772 Notice to Extended Family Members

DSHS 09-773 Notice of Termination or Adoption Decree Vacate

DSHS 09-774 Notice of Change of Voluntary Placement

DSHS 09-775 Inquiry to Indian Organization

DSHS 09-776 Notice of Dependency Dismissal

DSHS 09-777 Indian Child: Compliance Checklist

DSHS 09-778 Information to Prospective Adoptive Parents of Indian Child

DSHS 15-128 Verification of Indian Status: Foster Care and Adoptive Applicant