Form DCF-160 "Immediate Removal / 96-hour Hold Placement Notification" - Connecticut

What Is Form DCF-160?

This is a legal form that was released by the Connecticut State Department of Children and Families - a government authority operating within Connecticut. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on March 1, 2016;
  • The latest edition provided by the Connecticut State Department of Children and Families;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form DCF-160 by clicking the link below or browse more documents and templates provided by the Connecticut State Department of Children and Families.

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Download Form DCF-160 "Immediate Removal / 96-hour Hold Placement Notification" - Connecticut

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Department of Children and Families
IMM
IMMEDIATE REMOVAL/96-HOUR HOLD PLACEMENT NOTIFICATION
DCF-160
3/16 (Rev.)
Page 1 of 1
TO: Caretaker
Address: (No. and Street)
City
State
Zip
On this date:
The following child(ren):
Name of Child:
DOB:
Name of Child:
DOB:
Name of Child:
DOB:
Name of Child:
DOB:
Name of Child:
DOB:
is/are being placed in your care by the Department of Children and Families under the auspices of Connecticut General Statutes §17a-
101g, which allows the Department to remove a child from his/her home for up to 96 hours. This form hereby gives you the authority to
maintain this/these child(ren) in your home for the Department during this period, unless otherwise released by the Department.
The Social Worker assigned to this case can be reached by calling _______________________
Monday through Friday from 8:30 a.m. to 4:30 p.m.
On weekends, after office hours and holidays, you may reach the Department by calling the
Child Abuse and Neglect Careline at
1-800-842-2288.
Name of designated person who authorized this removal::
Title:
Immediate Removal Effective:
TIME:
Social Worker Name
Signature
Department of Children and Families
IMM
IMMEDIATE REMOVAL/96-HOUR HOLD PLACEMENT NOTIFICATION
DCF-160
3/16 (Rev.)
Page 1 of 1
TO: Caretaker
Address: (No. and Street)
City
State
Zip
On this date:
The following child(ren):
Name of Child:
DOB:
Name of Child:
DOB:
Name of Child:
DOB:
Name of Child:
DOB:
Name of Child:
DOB:
is/are being placed in your care by the Department of Children and Families under the auspices of Connecticut General Statutes §17a-
101g, which allows the Department to remove a child from his/her home for up to 96 hours. This form hereby gives you the authority to
maintain this/these child(ren) in your home for the Department during this period, unless otherwise released by the Department.
The Social Worker assigned to this case can be reached by calling _______________________
Monday through Friday from 8:30 a.m. to 4:30 p.m.
On weekends, after office hours and holidays, you may reach the Department by calling the
Child Abuse and Neglect Careline at
1-800-842-2288.
Name of designated person who authorized this removal::
Title:
Immediate Removal Effective:
TIME:
Social Worker Name
Signature