Form DCF-3004 "Court Notification of Otc Placement" - Connecticut

What Is Form DCF-3004?

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 July 1, 2018;
  • 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-3004 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-3004 "Court Notification of Otc Placement" - Connecticut

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Connecticut Department of Children and Families
COURT NOTIFICATION OF OTC PLACEMENT
DCF-3004
7/18 (Rev.)
Page 1 of 1
 SEALED / CONFIDENTIAL 
ATTENTION: Counsel for Child (or Children)
Pursuant to Connecticut Practice Book §33a-2, please note the following information regarding the
current residence / placement of the following child (or children).
Child 1 LAST Name:
Child 1 FIRST Name:
Child 1 DOB:
Child 2 LAST Name:
Child 2 FIRST Name:
Child 2 DOB:
Child 3 LAST Name:
Child 3 LAST Name:
Child 3 DOB:
Placement / Home Address
Contact Person (or Persons):
Phone Number:
Alternative Contact Information:
Address: (No. and Street):
City:
State:
Zip:
Connecticut
DCF Contacts
Investigative Social Worker Name:
ISW Phone Number:
ISW E-mail:
Treatment Social Worker Name:
TSW Phone Number:
TSW E-mail:
Treatment Supervisor Name:
TS Phone Number:
TS E-mail:
If there are any questions regarding the above contact information, please contact
DCF Area Office Attorney:
AO Attorney Phone Number:
AO Attorney E-mail:
NOTE: When filing this “Court Notification Of OTC Placement” form with the court,
please place in a sealed envelope marked
“ATTENTION: COUNSEL FOR CHILD (OR CHILDREN)” REGARDING: [Insert Child (or Children’s) Name(s)]
In addition, please send a copy via e-mail to:
pubdef.dcf.kids@jud.ct.gov
Connecticut Department of Children and Families
COURT NOTIFICATION OF OTC PLACEMENT
DCF-3004
7/18 (Rev.)
Page 1 of 1
 SEALED / CONFIDENTIAL 
ATTENTION: Counsel for Child (or Children)
Pursuant to Connecticut Practice Book §33a-2, please note the following information regarding the
current residence / placement of the following child (or children).
Child 1 LAST Name:
Child 1 FIRST Name:
Child 1 DOB:
Child 2 LAST Name:
Child 2 FIRST Name:
Child 2 DOB:
Child 3 LAST Name:
Child 3 LAST Name:
Child 3 DOB:
Placement / Home Address
Contact Person (or Persons):
Phone Number:
Alternative Contact Information:
Address: (No. and Street):
City:
State:
Zip:
Connecticut
DCF Contacts
Investigative Social Worker Name:
ISW Phone Number:
ISW E-mail:
Treatment Social Worker Name:
TSW Phone Number:
TSW E-mail:
Treatment Supervisor Name:
TS Phone Number:
TS E-mail:
If there are any questions regarding the above contact information, please contact
DCF Area Office Attorney:
AO Attorney Phone Number:
AO Attorney E-mail:
NOTE: When filing this “Court Notification Of OTC Placement” form with the court,
please place in a sealed envelope marked
“ATTENTION: COUNSEL FOR CHILD (OR CHILDREN)” REGARDING: [Insert Child (or Children’s) Name(s)]
In addition, please send a copy via e-mail to:
pubdef.dcf.kids@jud.ct.gov