1. (a) Provided that an applicant meets the requirements of this section, He-C 6447.04, and He-C 6447.06, the department shall issue a child-specific permit to an individual who is temporarily unable to meet the requirements for licensure.
2. (b) Denial of a permit under this part shall not automatically result in denial of a license, should the individual choose to apply for a kinship care home license under this part.

3. (c) Prior to the department issuing a permit, each applicant shall:

   1. (1) Disclose to the licensing agency all history of involvement with any state’s child protection and juvenile justice services agencies, and all contact with law enforcement for themselves and all household members;

   2. (2) Complete and submit Form 1601 “Kinship Caregiver Agreement” (September 2025). The applicant’s signature shall establish the applicant’s attestation that:

      “I have disclosed any history of child protection, juvenile justice, and law enforcement contact involving any member of the household to DCYF or licensing agency.

      I understand that additional record searches and background checks will be required during the home study process and agree that all household members will be subject to these searches and checks.

      I certify that DCYF or the licensing agency has observed my home and property and discussed any concerns with me. I agree to address any issues promptly.

      I will provide a loving, nurturing, and stable home free from abuse and neglect. I agree to provide discipline only in a safe, non-threatening, and constructive manner. I understand that physical and corporal punishment, including the use of spanking is prohibited.

      I will take the child(ren) to all medical and dental appointments and enroll the child(ren) in school (when of school age) as instructed by DCYF.

      I understand that the placement of the child(ren) may be temporary or long-term; DCYF will assess the parents’ ability to provide for the child(ren)’s needs, and DCYF shall reunite the child(ren) with the parent(s) when in the best interests of the child(ren) and when pursuant to a court order.

      I understand the primary goal is the safe reunification of the child(ren) with the parent(s) and agree to work with DCYF toward this goal of reunification.

      I understand that DCYF will work with the parent(s) to establish a case plan for the child(ren) and that this plan will be reviewed periodically. I agree to participate in the case plan when requested.

      I understand that DCYF will establish a visitation plan for the child(ren) to visit with their parent(s) and sibling(s), if applicable. I agree to collaborate with DCYF to establish and follow the visitation plan.

      I have discussed the safety concerns and issues about the child(ren)’s parental contact with DCYF, and I agree to cooperate and follow DCYF’s plan for parent contact. I understand that I must follow all supervision instructions set by DCYF and the Court for the child(ren) and their parents, and other parties as applicable.

      I agree to cooperate with DCYF, and all medical, dental, and mental health providers to ensure that the needs of the child(ren) are met within required timeframes.

      I agree to provide age and developmentally appropriate supervision to the child(ren).

      I agree to the following specific supervision plan, if applicable.

      I agree to notify DCYF of any unusual or unexpected behavior, special needs, educational concerns, medical needs, or other issues that are influencing or affecting the child(ren)’s behavior and development. I agree to work collaboratively with DCYF when concerns are identified.

      By signing below, I attest that the information provided above is true and correct to the best of my knowledge, and I understand that providing false or misleading information constitutes grounds for denial or revocation or placement, permit, or license.

      By signing below, I understand that I must complete and submit Form 2695 “DCYF Alternate W-9” (September 2025) if I wish to seek certification for payment, pursuant to He-C 6356, to be eligible to receive compensation for the costs associated with caring for a child placed in my home.

      I further understand that receiving compensation might impact public benefits available to me or the child, and I acknowledge that it is my responsibility to review these benefits to determine whether to seek certification for payment. I understand that a DCYF Representative cannot provide financial or legal advice to me.”

   3. (3) Sign the “Home Study Acknowledgement” section of Form 1601 upon the licensing agency’s completion of the home study, which shall constitute the applicant’s attestation that they reviewed the completed home study report and that the information they provided to complete the home study assessment and report is true and correct to the best of their knowledge;

   4. (4) Complete and submit Form 1606 “Kinship Caregiver Application” (September 2025). The applicant’s signature shall constitute the applicant’s authorization and statement of understanding of the requirements contained within the form as follows:

      “I have reviewed the Administrative Rule Chapter He-C 6447 and will comply with the rules if I am licensed or permitted. I authorize the NH Division for Children, Youth and Families (DCYF) to perform searches of the DCYF’s Electronic Information System for a history of child abuse and neglect reports and findings and the NH Department of Safety Registration of Criminal Offenders. I further authorize DCYF to receive the results of out-of-state child abuse and neglect registry checks.

      I attest that the information I provided on the Kinship Caregiver Agreement (Form 1601) is unchanged, or if there have been any changes, I have provided updated information to DCYF.

      I understand:

      DCYF reviews child abuse and neglect records and the criminal conviction records of the State Police of all applicants pursuant to RSA 170-E:29 and may revoke or deny any license of any applicant, permit holder, or licensee who knowingly furnishes or makes misleading or false statements or reports to DCYF. (RSA 170-E:35, V)

      All household members 18 years and older shall be subject to a criminal records search through the NH state and local police, and through all other states in which the individual has resided for the preceding 5 years, as well as a Federal Bureau of Investigation fingerprint-based criminal record check.

      Information shared about a child’s safety, the caregiver’s safety, and the appropriateness of the placement is confidential. (RSA 170-E:49)

      Information about the child’s family, or the circumstances of the child’s placement by DCYF, must be kept confidential. This information is part of the DCYF case record and its confidentiality is protected by state and federal law. Federal regulations prohibit the further sharing of this information without obtaining the written consent of the individual to whom it pertains, or as otherwise permitted by federal regulations. (42 CFR, Part 2)

      Completion and submission of this application is a statement of intention and may be withdrawn at any time by the applicant. Completion of this document does not constitute permit issuance or licensure by the department.

      DCYF will verify information contained in the Kinship Caregiver Agreement (Form 1601).

      I understand the statements on this form and certify that all statements made are true and correct.”

   5. (5) Meet with staff or representatives of the licensing agency and participate in the home study evaluation as described in He-C 6447.13.
4. (d) If an applicant wishes to seek certification for payment from the department pursuant to He‑C 6356 Certification of Payment Standards for Kinship Care, the applicant shall complete and submit Form 2695 “DCYF Alternate W-9” (September 2025).

5. (e) To provide for the health, safety, and well-being of a child in care, each applicant shall demonstrate, through the home study evaluation and other documentation, their ability to and willingness to:

   1. (1) Manage their own daily living activities, such as preparing meals, housekeeping, shopping for groceries, and bathing;
   2. (2) Provide a child in care with basic needs, including but not limited to food, clothing, shelter, and supervision;
   3. (3) Maintain a safe, nurturing, and stable family environment, which is free from abuse and neglect;
   4. (4) Meet the child’s dietary needs and accommodate all food allergies and dietary restrictions;
   5. (5) Ensure that the child in care receives routine and emergency health care and mental health care;
   6. (6) Provide and administer medications, including prescription medications, as directed by the child’s medical provider(s); and
   7. (7) Access safe and reliable transportation so that the child attends appointments and activities.
6. (f) Each applicant shall demonstrate, through the home study evaluation and other documentation as requested by the licensing agency, they are free of physical, mental, or emotional illness which would inhibit their ability to provide appropriate and adequate care for a child placed in their home.
7. (g) If an applicant or any household member possesses any firearms, the individual shall comply with all applicable federal and state laws related to the licensing, ownership, carrying, and storage of a firearm, including but not limited to RSA 159, RSA 650-C:1, and 18 USC 921 et seq.

Source. #14390, eff 9-24-25, EXPIRES: 9-24-35