1. (a) Each individual applying for licensure to care for a child who is subject to the Interstate Compact on the Placement of Children (ICPC) shall meet the requirements of He-C 6447.04 through He-C 6447.08 except He-C 6447.05(c)(2) - (c)(4).

2. (b) Each applicant shall complete and submit Form 1586 “ICPC Kinship Caregiver Agreement” (September 2025). The applicant’s signature on the form shall constitute the applicant’s attestation of the following:

   “I have reviewed and will comply with Administrative Rule He-C 6447.

   I have disclosed any history of child protection, juvenile justice, and law enforcement contact involving any member of the household to New Hampshire Division for Children Youth and Families (NH DCYF) and the Sending State Agency.

   I certify that NH DCYF staff have observed my home and property and have been given access to tour all common areas of the property and home, including the child’s sleeping space. Any concerns or issues found were discussed with me.

   I agree to allow NH DCYF staff into my home for home visits, supervision of this child in care, investigations, and observation.

   I agree to notify NH DCYF and the Sending State Agency any time there are changes to the property, home, household composition, and any other change identified in He-C 6447.28.

   I agree to provide a safe, nurturing, and stable family environment, which is free from abuse and neglect, for the child in care and will work collaboratively with the Sending State Agency to meet the individual needs of the child; including the child's safety, permanency, health, and well-being needs; and their mental, emotional, and physical development.

   I agree to collaborate with the Sending State Agency and the child’s medical, dental, and mental health providers to ensure that the safety, health, and well-being needs of the child in care are met.

   I agree to provide age and developmentally appropriate supervision to the child in care.

   I agree to support the child’s education plan as established by the Sending State Agency.

   I agree to notify NH DCYF, local law enforcement, and the Sending State Agency of the child’s unauthorized absence from the home, including circumstances when the child in care runs away or is missing.

   I agree to promptly notify NH DCYF and the Sending State Agency of any unusual or unexpected behavior, educational concerns, special needs, medical care, or other issues that might influence or affect the child’s behavior, health, development, and safety. (He-C 6447.28)

   I agree to abide by all of the applicable NH laws and Administrative Rules and all requirements set by the Sending State Agency in accordance with Interstate Compact on the Placement of Children (ICPC) regulations.

   By signing below, I attest that I have reviewed and will comply with Administrative Rule He-C 6447 and agree to the statements on this form. I acknowledge that I have reviewed the completed home study and that the information I provided to complete the assessment 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.”

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