Form JV-214 "Request for Hearing on Waiver of Presumptive Transfer" - California

What Is Form JV-214?

This is a legal form that was released by the California Superior Court - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on September 1, 2018;
  • The latest edition provided by the California Superior Court;
  • 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 JV-214 by clicking the link below or browse more documents and templates provided by the California Superior Court.

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Download Form JV-214 "Request for Hearing on Waiver of Presumptive Transfer" - California

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Request for Hearing on Waiver of
Clerk stamps date here when form is filed.
JV-214
Presumptive Transfer
Use this form to request a court hearing to challenge the decision made by
the placing agency on the request for waiver of presumptive transfer of the
responsibility for specialty mental health services. (Read form JV-214-
INFO, Instructions for Requesting a Hearing to Review Waiver of
Presumptive Transfer of Specialty Mental Health Services).
My relationship to the child or nonminor:
1
a.
Self
b.
Person or agency responsible for making mental health decisions
Fill in court name and street address:
on behalf of the child or nonminor
Superior Court of California, County of
c.
The child’s or nonminor’s attorney
d.
Parent or legal guardian
e.
Other:
My contact information (if confidential, use form JV-287):
2
Fill in child's name and date of birth:
a.
Name:
Child's/Nonminor's Name:
Street address:
b.
City/State/Zip:
c.
Date of Birth:
Telephone number:
d.
Court fills in case number when form is filed.
E-mail address:
Case Number:
e.
The child or nonminor is placed or will be placed in a county that is not the county of original jurisdiction (home
3
county). The out-of-county placement is in (name county):
county.
A request was made to the agency making this placement that the responsibility for providing specialty mental
4
health services to the child or nonminor shoud be waived and not transferred to the new county. That request was
made on (date)
by (name):
.
On (date):
, the agency making the placement informed me:
5
a.
That an exception or waiver applies to the rule that the responsibility for providing specialty mental health
services be transferred to the county where the child or nonminor lives or will live, and the responsibility
should remain with the child’s or nonminor’s home county.
b.
That the request for the waiver of the responsibility for the child’s or nonminor’s specialty mental health
services is denied and the responsibility for those services should be transferred to the new county of
residence.
I disagree with the agency’s decision about transferring the responsibility for specialty mental health services to the
6
new county, as follows:
a.
The responsibility for the child’s or nonminor’s specialty mental health services should transfer to the county
where the child or nonminor lives or will live.
Judicial Council of California, www.courts.ca.gov
Request for Hearing on
JV-214,
Page 1 of 2
New September 1, 2018, Mandatory Form
Welfare and Institutions Code, § 14717.1
Waiver of Presumptive Transfer
Request for Hearing on Waiver of
Clerk stamps date here when form is filed.
JV-214
Presumptive Transfer
Use this form to request a court hearing to challenge the decision made by
the placing agency on the request for waiver of presumptive transfer of the
responsibility for specialty mental health services. (Read form JV-214-
INFO, Instructions for Requesting a Hearing to Review Waiver of
Presumptive Transfer of Specialty Mental Health Services).
My relationship to the child or nonminor:
1
a.
Self
b.
Person or agency responsible for making mental health decisions
Fill in court name and street address:
on behalf of the child or nonminor
Superior Court of California, County of
c.
The child’s or nonminor’s attorney
d.
Parent or legal guardian
e.
Other:
My contact information (if confidential, use form JV-287):
2
Fill in child's name and date of birth:
a.
Name:
Child's/Nonminor's Name:
Street address:
b.
City/State/Zip:
c.
Date of Birth:
Telephone number:
d.
Court fills in case number when form is filed.
E-mail address:
Case Number:
e.
The child or nonminor is placed or will be placed in a county that is not the county of original jurisdiction (home
3
county). The out-of-county placement is in (name county):
county.
A request was made to the agency making this placement that the responsibility for providing specialty mental
4
health services to the child or nonminor shoud be waived and not transferred to the new county. That request was
made on (date)
by (name):
.
On (date):
, the agency making the placement informed me:
5
a.
That an exception or waiver applies to the rule that the responsibility for providing specialty mental health
services be transferred to the county where the child or nonminor lives or will live, and the responsibility
should remain with the child’s or nonminor’s home county.
b.
That the request for the waiver of the responsibility for the child’s or nonminor’s specialty mental health
services is denied and the responsibility for those services should be transferred to the new county of
residence.
I disagree with the agency’s decision about transferring the responsibility for specialty mental health services to the
6
new county, as follows:
a.
The responsibility for the child’s or nonminor’s specialty mental health services should transfer to the county
where the child or nonminor lives or will live.
Judicial Council of California, www.courts.ca.gov
Request for Hearing on
JV-214,
Page 1 of 2
New September 1, 2018, Mandatory Form
Welfare and Institutions Code, § 14717.1
Waiver of Presumptive Transfer
Case Number:
Child's/Nonminor's Name:
6
The following exception to presumptive transfer should be applied and the responsibility for providing or
b.
arranging specialty mental health services should remain with the child’s or nonminor’s home county:
(1)
The transfer would disrupt continuity of care or delay access to services provided to the child or
nonminor.
(2)
The transfer would interfere with family reunification efforts documented in the individual case plan.
(3)
The child’s or nonminor’s placement in a county other than the county of original jurisdiction is
expected to last less than six months.
(4)
The child’s or nonminor’s residence is within 30 minutes of travel time to his or her established
specialty mental health care provider in the county of original jurisdiction.
My request in
6
is in the child’s or nonminor’s best interests because (explain the best interest to the child or
7
nonminor and provide a brief factual description of the exception to presumptive transfer selected in item 6b):
I am requesting that the court grant a hearing on this matter.
8
On (date):
I informed the placing agency that I was requesting a court hearing to review
9
the decision on presumptive transfer by providing the placing agency with a copy of this form.
Date:
Type or print your name
Sign your name
Request for Hearing on
New September 1, 2018
JV-214,
Page 2 of 2
Waiver of Presumptive Transfer
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