"Request for Investigation" - Illinois

Request for Investigation is a legal document that was released by the Illinois Department of Children and Family Services - a government authority operating within Illinois.

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OFFICE OF THE INSPECTOR GENERAL
Illinois Department Of Children And Family Services
2240 W. Ogden Ave., Chicago, Il 60612
(312) 433-3000, Fax: (312) 433-3032
REQUEST FOR INVESTIGATION
(Please print or type. Attach additional sheets if necessary.)
1. Your Name
Street
Apt.
City
State
Zip
Daytime Phone
Evening Phone
Your relationship to Child(ren) Involved
2. The OIG may only investigate wrongdoing of DCFS employees, private agencies, or private agency
employees and foster parents. Please describe what DCFS or its contracting agency did or failed to do that
you believe may have been improper. Be as specific as possible and include information such as dates, times,
places, names, and telephone numbers or other persons involved. Attach copies of any documents that
support your complaint.
3. Child(ren) Involved:
a. Child’s Name
Birthdate
Foster Home or Other Placement
Street
City
State
Zip
Phone
OFFICE OF THE INSPECTOR GENERAL
Illinois Department Of Children And Family Services
2240 W. Ogden Ave., Chicago, Il 60612
(312) 433-3000, Fax: (312) 433-3032
REQUEST FOR INVESTIGATION
(Please print or type. Attach additional sheets if necessary.)
1. Your Name
Street
Apt.
City
State
Zip
Daytime Phone
Evening Phone
Your relationship to Child(ren) Involved
2. The OIG may only investigate wrongdoing of DCFS employees, private agencies, or private agency
employees and foster parents. Please describe what DCFS or its contracting agency did or failed to do that
you believe may have been improper. Be as specific as possible and include information such as dates, times,
places, names, and telephone numbers or other persons involved. Attach copies of any documents that
support your complaint.
3. Child(ren) Involved:
a. Child’s Name
Birthdate
Foster Home or Other Placement
Street
City
State
Zip
Phone
b. Child’s Name
Birthdate
Foster Home or Other Placement
Street
City
State
Zip
Phone
c. Child’s Name
Birthdate
Foster Home or Other Placement
Street
City
State
Zip
Phone
4. Name of DCFS Caseworker
Name of DCFS Supervisor, if known
Address
Telephone Number
5. Name of agency contracting with DCFS (if applicable)
Name of Private Agency Caseworker
Name of Private Agency Supervisor, if known
Address
Telephone Number
6. Complainants are encouraged to resolve issues with DCFS workers or private agency workers or with
the DCFS supervisor or the Director of the private agency involved.
Have you attempted to resolve this issue with the supervisor/private agency Director?
Yes
Date
No
Explain
7a. Have you attempted to resolve this issue through Service Appeal?
Yes
No
Please explain
7b. Are the facts of this complaint the subject of a pending court case:
o Yes
o No
Divorce/Custody
o Yes
o No
Paternity
o Yes
o No
Child Support
(Be advised that the OIG does not have jurisdiction over Court orders or decisions and procedures. We do not
investigate issues that can be resolved through the service appeal process unless the subject of the complaint
is the service appeal process itself.)
NOTE: In the course of conducting its investigation, the OIG will examine all facts relevant to this case. The
scope of the investigation will not necessarily be limited to the issues raised in your complaint. The OIG will
investigate any and all matters that fall within its jurisdiction. It is possible that our investigation will not be
resolved to your satisfaction. If a report is completed as a result of your complaint, the report is submitted to the
Director of DCFS and is not necessarily shared with the complainant.
Date
Signature
PLEASE RETURN TO:
Bill Andersen, Office of the Inspector General, Department of Children and Family Services, 2240 West
Ogden Avenue, Chicago, Illinois 60612
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