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All required activities and Structured Decision Making forms shall be completed prior to making a case decision.
Absent additional allegations, the case decision shall reflect a finding of dependency.
There shall be documentation in the file indicating that the identity of the parent(s) is unknown as this was a safe surrender.
The DSS-5104 shall be completed by the county that conducted the assessment.
Special considerations must be taken into account when completing the DSS- 5104 in regard to cases of safe surrender.
In cases where a safe surrender occurs, in which there are simultaneous allegations of abuse or neglect involving other children in the home, only one DSS-5104 with one form number should be completed. For the child involved in the safe surrender, the type reported and type found should be dependency, and the maltreatment type found should be safe surrender. All other children and perpetrators on the form should be entered using the standard procedures outlines in the Central Registry Users Manual.
1. Instructions for completing the DSS-5104
a. Field 1-8. Entry Required
Enter fields 1 through 8 using standard procedures for completing the DSS 5104. The family risk assessment should be completed to the best of the social worker’s ability with the information available.
b. Field 9. Child ID Entry Required
If the child already exists in SIS, enter the SIS Client ID on the form. If the alleged victim child does not already exist in SIS, obtain a new SIS Client ID and enter it on the form.
Please note that it is especially important to diligently record the SIS Client ID in cases of safe surrender, as there may be numerous clients named “Baby Boy” or “Baby Girl” in the system that do not have a known birth date or social security number.
c. Field 10. Child Name Entry Required
If the child already exists in SIS, enter the last name, first name, and middle initial as it appears in the SIS system. This name will be verified at data entry when the SIS Client ID is keyed. If the alleged victim child does not already exist in SIS, enter the last name, first name, and middle initial of the child.
If the child’s name is unknown, enter the child’s last name as “Girl” or “Boy” based upon the sex of the child, and the child’s first name as “Baby”. The middle initial may be left blank. Once a legal name has been obtained for the child, update the DSS-5027 to update the information in the SIS system.
d. Field 11. Child Social Security Number
Note: If the alleged victim child already existed in SIS, fields 11-18 will be populated with the information from SIS. If the alleged victim child does not already exist in SIS, then entry for fields 11-18 will be required.
If the retrieved information is incorrect, update the current DSS-5027 to reflect the accurate information.
If the child already exists in the SIS system, leave blank, this will be populated by information in SIS. If the child does not exist in SIS enter the alleged victim child's Social Security Number. If the child does not have a Social Security Number or if the number is unknown, enter all "9's". Once the child’s Social Security Number has been attained, complete a DSS-5027 to update the Social Security Number in the SIS system.
e. Field 12. Date of Birth
If the alleged victim child already exists in the SIS system, leave blank, this will be populated by information in SIS. If the child does not exist in SIS, enter the alleged victim child's date of birth. Enter the month, day, and year [use a leading zero (0) for any month or day less than ten (10)].
If the child’s date of birth is unknown, estimate the date of birth to be seven days prior the date of initial report.
f. Field 13. Sex
Enter sex using standard procedures for the DSS-5104.
g. Field 14. Race/Ethnicity
Enter race/ethnicity using standard procedures for the DSS-5104. If the parent is unavailable to report the child’s race and ethnicity, use code “11 – Unable to Determine”.
In cases of safe surrender, enter In School code “N – child is not enrolled in school”.
i. Field 16. Grade
In cases of safe surrender, enter Grade code “99 – Unable to Determine”.
j. Field 17. Living Arrangement
In cases of safe surrender, enter Living Arrangement code “99 – Unknown”.
k. Field 18. Special Areas
If the alleged victim child already exists in the SIS system, leave blank, this will be populated by information in SIS. If the alleged victim child does not exist in SIS, enter in the appropriate two digit code. You may enter up to three codes per child. For cases of safe surrender, enter Special Areas using standard procedures for completing the DSS-5104.
For more information on this field please view the SIS Manual.
l. Field 19. Source of Referral Entry Required
Enter the two (2) digit code for the source of referral using standard procedures for the DSS-5104. The referral source in cases of safe surrender is the person to whom the child was given.
m. Field 20. Petition Filed with Juvenile Court Required if Applicable
Check this block if a petition has been filed in Juvenile Court in relation to the situation of abuse/neglect/dependency.
n. Field 21. Criminal Charges Filed
In cases of Safe Surrender, criminal charges should not be filed and this box should be left unmarked.
o. Field 22. Perpetrator Relationship Code
Because safe surrender is considered a finding of dependency, the Perpetrator Relationship code should remain blank.
p. Field 23. Services Provided Required if Applicable
Enter Services Provided using standard procedures for the DSS-5104.
q. Field 24. Failure to Report Source
In cases of safe surrender, Failure to Report Source should remain blank.
r. Field 25. Failure to Report Reason
In cases of safe surrender, Failure to Report Reason should remain blank.
s. Field 26. Contributory Factors
Enter Contributory Factors using standard procedures for the DSS-5104. In many instances, this field may remain blank.
t. Field 27. Type Reported Entry Required
In cases of safe surrender, the Type Reported should be code “4 – Dependency”.
u. Field 28. Maltreatment Type Reported
Since safe surrender cases require that the Type Reported is dependency, the Maltreatment Type Reported should be left blank.
v. Field 29. Type Found Entry Required
In cases of safe surrender, the Type Found should be coded “04 – Dependency”.
w. Field 30. Findings Reason
Because the Type Found code in Field #29 is dependency, Findings Reason should remain blank.
x. Field 31. Maltreatment Type Found Entry Required
In cases of Dependency that do not involve safe surrender, the Maltreatment Type Found field is left blank. In cases of safe surrender, the “Safe Surrender” option listed in the Neglect column should be selected. The Neglect Type “Abandonment” should not be prioritized.
y. Fields 32 – 39 Perpetrator(s)
In cases of safe surrender, the Type Found is “dependency”; thus no perpetrator information is entered.
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For questions or clarification on any of the policy contained in these manuals, please contact your local county office.
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