1. (a) Provided that the applicant meets the requirements of He-C 6447.04 through He-C 6447.06 and this section, the department shall issue a kinship care home license.
2. (b) Prior to the department issuing a license, the applicant and household members shall participate in home visits as described in He-C 6447.13 for the completion of the home study assessment and written evaluation.

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

   1. (1) A completed Form 1717 “Local Law Enforcement Check” (September 2025) in accordance with He-C 6447.10;
   2. (2) A completed and signed Form 2501 “NH Child Abuse and Neglect Central Registry Authorization for Name Search and Release of Information to a Third Party” (May 2025) for themselves and a form completed by each adult household member, in accordance with He-C 6447.11;
   3. (3) A completed and signed Form 1728 “Pre-Adoptive and Foster Family Care License Financial Statement” (September 2025) attesting “I certify that my income, assets, and expenses as stated herein are true to the best of my knowledge and belief. I have carefully read this financial statement.”;
   4. (4) Three references in accordance with He-C 6447.12;
   5. (5) If applicable to the needs of the child in care, the applicant’s and each adult household member’s vaccination record in accordance with He-C 6447.21;
   6. (6) Proof of rabies vaccination for each dog, cat, and ferret in the home, pursuant to RSA 436:100; and
   7. (7) Proof of caregiver training completed in accordance with He-C 6447.14.
4. (d) Each applicant and all adult household members shall complete the process established by the New Hampshire department of safety for requesting a fingerprint-based criminal records check as described in He-C 6447.10 and required by RSA 170-E:29.
5. (e) If the applicant is not the property owner of the home, verification of good standing shall be obtained from the proprietor or owner of the property and submitted to the licensing agency.

6. (f) If the applicant or any adult household member has lived outside the state of New Hampshire within the preceding 5 years, they shall submit or cause to be submitted to the licensing agency:

   1. (1) The results of the state(s) and local criminal history records search(es) for each state resided within the preceding 5 years pursuant to He-C 6447.10(d); and
   2. (2) The results of the state(s) child abuse and neglect registries for each state resided within the preceding 5 years pursuant to He-C 6447.11(b).

7. (g) If an individual’s health concerns are observed, reported, or discovered during the home study evaluation that might impact the applicant’s or household member’s ability to provide care and supervision or might negatively impact the health, safety, or well-being of the child in care, upon request of the licensing agency, the individual shall complete and submit Form 1722 “Medical Information Statement” ( September 2025) as follows:

   1. (1) Form 1722 shall be completed in 2 parts:

      1. a. The first by the individual certifying:

         “By signing below, I authorize the following named healthcare provider to release my PHI listed below and any other information required by the assessment and evaluation and findings requested on this form, specifically the disclosure of any PHI that may be specified in Section 2 of this form, to the above named licensing agency and the department of health and human services, division for children, youth and families. I understand I am not required to sign this form, however, if I do not sign, the healthcare provider will not share my PHI included in the medical evaluation and assessment, and the licensing agency will not be able to process my application.”; and

         “I understand that the department of health and human services, division for children, youth and families, and the licensing agency may use the disclosed information to the extent permitted by state and federal law and may no longer be protected by the HIPAA federal privacy rule (45 CFR Part 164.508(c)). I understand I can revoke my permission at any time by writing to the licensing agency. This authorization will expire 2 years from the date I sign below.”; and

      2. b. The second by a physician, physician assistant, or nurse practitioner who shall then submit the completed form to DCYF; and
   2. (2) If the information provided on Form 1722 “Medical Information Statement” ( September 2025) is incomplete, inadequate, or contradictory to other information received or obtained, and the applicant is unable to provide information to clarify or resolve the conflict, the licensing agency shall require that the individual obtain a medical or psychological evaluation, and the written results of the evaluation shall be submitted to DCYF by the medical professional performing the evaluation.
8. (h) When additional information or documentation is required in addition to the requirements in (c)-(g) above for the licensing agency to thoroughly assess the character or abilities of the applicant or adult household member(s) to safely care for the child, or to fully evaluate the home for suitability of licensure, the licensing agency shall notify the applicant and specify the additional information or documentation required, and the applicant shall submit it within 30 days of notice as a condition of the application being deemed sufficient and complete for processing.
9. (i) Upon receipt of the information in (c)-(h) above, the department shall review and process the complete application in accordance with RSA 541-A:29.

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