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Payment Request Information

PAYMENT REQUEST INFORMATION (PRI) FORM

We are now moving onto to adoption subsidy negotiations. DCS has requested that you fill out their Payment Request Information (PRI) form so that they may gather the information they believe they need in order to make an initial subsidy offer. After we provide this completed form to DCS a subsidy negotiator will be assigned. That subsidy negotiator will then contact me with either an initial subsidy offer or a request for additional financial information.

Please fill this form out and use additional sheets if necessary. DCS will want to see documentation to back up any expenses or income you have (see the last page of the form you will download below).

IMPORTANT: For those of you that are aiming to get 100% of your per diem amount please pay attention to this. In my experience, the families that I see that get 100%, or close to 100%, are the families that compile 200-300 pages of documentation to support this request. It is always very organized (pages are all facing the same direction and all pages are in order), sometimes with a table of contents. It includes accounting for every penny the family spends each year along with notes from doctors, teachers, and therapists. Not everyone that does this gets 100%, but it should help yield a higher subsidy offer from DCS.

Click on the correct link below based on how many children you are adopting at this time. After you click on the link the PRI form will open up in Google Drive. From your computer you will then click the download arrow at the top right of the screen. Save this to your desktop and then print out the form so that you can fill out by hand. DCS will not accept the form if you fill out it electronically. DCS wants to see that you physically signed the form with a pen.

1 Child
2 Children
3 Children
4 Children
5 Children
6 Children

After you compile everything please scan it all into one PDF and email that PDF to me. Please make sure to scan it in a low resolution. Do not scan in photo quality. The DCS email server has a file size limit so we need to keep it under 20MB.

Please try to get this back to me within a week so that we can keep things moving forward.