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CFS 1800–B–G
Rev 8/2012
1 of 6
State of Illinois
Department of Children and Family Services
SUBSIDIZED GUARDIANSHIP APPLICATION
(SECTION I TO BE COMPLETED BY THE WORKER)
If you do not wish to apply for subsidized guardianship, complete Sections I, II and III.
If you wish to apply for subsidized guardianship, complete Sections I, II and IV.
I. GUARDIAN AND CHILD INFORMATION
Guardian Home Telephone Number
Guardian
Address City State Zip Code
/ /
Child’s Name Date of Birth
II. INFORMATION REGARDING SUBSIDIZED GUARDIANSHIP
Following is information regarding the availability of subsidized guardianship for the child for whom you are
planning to assume guardianship. Please indicate the types of subsidized guardianship for which you wish to apply.
1. Nonrecurring Expenses for Subsidized Guardianship
This is a one-time only payment for reasonable and necessary miscellaneous costs and legal fees related to
subsidy review, that are directly related to the transfer of guardianship of a child, subject to the maximum set
by the Department of $2000 per child. The non-recurring cost limit is $500 for cases of a subsequent
guardianship after the death/incapacitation of a guardian in which the initial guardianship was established
under the IDCFS Subsidized Guardianship Waiver.
I request this assistance. I do not request this assistance.
2. Monthly Cash Payment
The amount of the monthly cash payment is determined in accordance with DCFS Rules and Procedures
302.410 and shall not exceed the amount the child receives in the current licensed foster family home.
I request this assistance. I do not request this assistance.
Illinois Guardianship Form
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