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If you are providing kinship care for a child who is involved with SCDSS, Kinship Caregivers can expect to see these forms: 

The Safety Plan (DSS Form 3087)

This is a voluntary written agreement signed by parents, the kinship caregiver and SCDSS. It is not a court order, but it outlines what each person agrees to do to keep the child safe in the caregiver’s home.

A Kinship Care Agreement (DSS Form 3018)

This document explains the roles and responsibilities of the kinship caregiver, parents and SCDSS. While working on this agreement, kinship caregivers should feel free to ask questions. This is an important step toward understanding caregiver roles and responsibilities.

The Child Profile (DSS Form 3017)

This information about the child includes any special needs for education, medical treatment or counseling services, as well as the child’s primary care doctor and other doctors the child sees.

A Kinship Caregiver Site Visit Form (DSS Form 30212)

The SCDSS case manager fills out this form while visiting the kinship caregiver’s home to check for safety concerns.

Affidavit for Kinship Care Placement Form (DSS Form 3042)

All adults 18 and older in the kinship caregiver’s household must have background checks that include criminal, sex offender registry and child protective services records. Every adult household member must complete and sign this form.

Child Welfare Services Transformation

Best Outcomes for Children and Families

Do you have a complaint regarding services being provided to a child by a state agency? Please submit your complaint by phone (1-800-206-1957) or an electronic submission form here with the South Carolina Department of Children's Advocacy.