Documents Required for an Adoption Home Study (Illinois)

1. 1. Home Study Application
   2. Autobiography Questionnaire from each adopting parent (will be emailed by the caseworker prior to first visit)
   3. Marriage Certificate/ Divorce Decree (if applicable)
   4. Certificate for each family member
   5. Military Discharge/ Death Certificate (if applicable)
   6. Criminal and Child Abuse Checks- (MAA’s ORI number is ILL14050S, Purpose Code: AWA)
      a) Live fingerprint scanning for IL state police and FBI clearances for anyone 18 years and older residing in the home.
      b) Child Abuse Clearance on each member of household 13 years and older (CANTS Form CFS 689).
      c) Criminal Clearance Form for any other states lived in for the past 5 years (done by caseworker)
      d) If Hague case, child abuse clearances must be submitted for every state lived in since age 18 (done by caseworker)
      e) Affirmation Statement for Hague (must be notarized)
      f) IL Sex Offender Registry check (done by caseworker)
      g) National Sex Offender Registry check (done by caseworker)
   7. Medical Requirements
      a) Certificate of Physical Examination (per adult in home and completed within last 6 months; must be notarized)
      b) CFS 600 Certificate of Child Health Examination (per child in home)
      c) Letter of Recommendation Provided for any household members over age 18 with previous mental/behavioral health service history (includes counseling, psychiatry, or persons using medication; Must be notarized)
   8. Financial Forms
      a) Last 2 years of federal income tax returns
      b) Financial Statement
      c) Letter from employers which state occupation title, salary, and length of service. Must include an actual signature (must be notarized)
   9. Five (5) Letters of References
   10. Proof of Life Insurance photocopy of face of policy, company name and amount of policy
   11. Proof of Health Coverage photocopy of policy or card
   12. Guardian Designation Form (guardians must submit a letter to MAA acknowledging their responsibility)
   13. Parent Education Training Package and Training Certificates reflecting 10 hours of Hague training (12 hours required for China adoption)
       a) 4 of the 10 required hours of training must be face-to-face training
       b) Additional 4 hours training required for special needs adoption specific to child’s needs
       c) Certificate of Adoptive Parent Training & Training Verification (to be completed with caseworker)
   14. IL Required Forms/ Attestations
       a) DCFS Criminal Conviction/ Arrest History Statement (must be notarized)
       b) CFS403-D Form IL Adoptive Parents Rights and Responsibilities
       c) CFS 452 Well Water Agreement (if applicable; to be completed with caseworker)
       d) CFS 452-1 Water Temperature Agreement (if applicable; to be completed with caseworker)
       e) CFS 452-2 Foster Family Firearms Agreement (if applicable)
       f) CFS 452-4 Child Supervision Plan Agreement
       g) CFS 452-5 Safety Plan for Pools, Hot Tubs, Ponds & Other Potential Water Hazards (if applicable)
       h) CFS 585 Document of Inspection of Smoke Detector in Foster Home (to be completed with caseworker)
       i) CFS 585-1 Fire Evacuation Plan (to be completed with caseworker)
       j) Pet Vaccination Record (if applicable) – Parents must request this from their veterinarian
       k) Well and Septic Check Report (if using well water, parents must supply proof of water testing.)
   15. MAA Discipline Recommendation Form (to be completed with caseworker)
   16. Client Rights and Complaint Procedures
   17. Post-Adoption Report Commitment Form
   18. Home Study Fee Acknowledgement Sheet (fee due before caseworker visits the home)
   19. Notarized Home Study Contract