AdoptionAssistanceRateDeterminationWorksheet：通过援助ratedetermination表.docVIP

ADOPTION ASSISTANCE RATE DETERMINATION WORKSHEET Michigan Department of Human Services Initial Renegotiation (Optional – the family may request a rate renegotiation when extraordinary circumstances occur that will impact the child’s needs or family circumstances over an extended period of time) Child’s Name Date of Birth Prospective/Adoptive Parent(s) Name(s) Caseworker Name and Agency (required if initial request) Caseworker Telephone Number (required if initial request) INSTRUCTIONS: Federal law requires that the adoption support assistance rate be negotiated. See 42