Interstate Compact for Juveniles Forms and Descriptions



Following is a list of all forms and their descriptions in an Adobe pdf file format.  The forms can downloaded by clicking on the link next to the Adobe Acrobat Reader (.pdf) icon: pdf icon. You can get the free Adobe Acrobat Reader to access the form in Adobe Acrobat format.

All forms have been reviewed and updated as of 2/1/16. Please download the updated forms as provided on these pages and destroy older forms you may have saved.

In addition, forms that require juvenile signatures or form with provided information have been translated into Spanish. Please see Forms IA/VI, VII, III, and Juvenile Rights.

 

Request for Supervision Forms

Form IV:  Parole or Probation Investigation Request (front and back) (revised 2/1/16)

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This required form provides key information regarding the juvenile and the proposed home placement resource, including relationship, in the proposed receiving state. The home juvenile probation / parole officer completes Form IV along with the other forms listed in this section, to request an investigation for possible placement of a probationer or parolee in a home in another state. It should be accompanied with pertinent court orders, social summary, evaluation results, and court, school, and medical records.This form contains an instruction page.

Distribution: One copy of Form IV without the instruction page in each of the three referral packets submitted to the Texas ICJ Office.


Form IA/VI: Application for Compact Services/Memorandum of Understanding & Waiver (revised 2/23/15) 

pdf icon PDF Format (English with Instructions)
pdf icon PDF Format (Spanish without Instructions/Español sin Instrucciones)
pdf icon PDF Format (English & Spanish without Instructions/Ingleés y Español sin Instrucciones)

This required form is comprised of two parts. In the Form IA: Application for Compact Services, the probationer/parolee requests permission from the sending juvenile probation / parole authority and ICJ authorities in both states to accept his/her application for Compact services. The juvenile states that she/he understands that there will be differences in supervision from one state to the other but agrees to those differences as the privilege of moving to the other state is worth any adjustments that may occur. The Form VI, Memorandum of Understanding & Waiver, is a voluntary pre-signed waiver and provides the due process requirements for the juvenile's return to the sending state in the event this becomes necessary. The waiver requires a witness to attest to the signatures provided by the juvenile and placement resource.

In the form, the juvenile agrees to three provisions: (1) stay with the placement resource and at the address where he/she is requesting to live until a change is authorized by the supervising juvenile probation / parole officer, (2) live up to the terms of probation / parole as fixed by both the sending and receiving states, and (3) return at any time to the sending state if asked to do so by the sending state.  The placement resource agrees to the terms of the agreement and waives any right to contest the juvenile’s return if he/she is required to return to the sending state, and consents to cooperate with the juvenile authorities.  In the last section, if the juvenile is a probationer, the adjudicating juvenile judge approves the juvenile’s application to request supervision through ICJ and if approved by that state, the juvenile is approved by the adjudicating court to reside in the other state.  If the juvenile is a parolee, the sending state’s compact official is required to sign if approved.

Distribution: One copy of Form IA/VI without the instruction page in each of the three referral packets of the referral submitted to the Texas ICJ Office.


LS-024: Youth's Consent for Disclosure to Persons Other Than Parents or Juvenile Court Officials (Federal Confidentiality Law)(revised 9/12)

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Federal regulations governing Confidentiality of Alcohol and Drug Abuse Patient Records, 42 CFR Part 2, state that these records are protected and cannot be disclosed without the juvenile's written consent. This consent cannot be obtained by the receiving state. The form must be completed and filled out prior to the juvenile leaving the sending state.

Distribution: One copy in each of the three referral packets submitted to the Texas ICJ Office.


Form V: Report of Sending State Upon Parolee or Probationer Leaving the Sending State (revised 1/1/11) 

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This required form is used to notify the receiving state of the juvenile’s travel plans and is to be forwarded prior to placement if the juvenile is not already residing in the receiving state. In the case of a juvenile probationer departing to the receiving state prior to the referral materials being sent to that state, the juvenile must be instructed to continue reporting to the sending state’s juvenile probation officer. The Form VII is used as a supplement to Form V. It is the responsibility of the supervising juvenile probation officer to ensure that the juvenile receives a copy of Form VII and he/she is instructed to carry it on his/her person at all times until supervision is picked up in the receiving state.

Distribution: One copy in each of the three referral packets submitted to the Texas ICJ Office.


Form VII: Out-of-State Travel Permit and Agreement to Return (revised 2/1/16)

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pdf icon PDF Format (Spanish without Instructions/Español sin Instrucciones)
pdf icon PDF Format (Dual English & Spanish without Instructions/Inglés y Español sin Instrucciones)

This (required) form, is to be issued for any appropriate purpose, including but not limited to testing a proposed placement. The permit is not to exceed ninety (90) calendar days, with a referral packet to be received by the receiving state’s ICJ Office within thirty (30) calendar days of the effective date of the Travel Permit. Travel Permits are to be issued for visits that exceed forty-eight (48) hours. Travel Permits are to contain instructions requiring the juvenile, who is subject to the terms of the ICJ, to return to the sending state. Regardless of length of stay, travel permits are to be issued to all juveniles subject to the terms of the ICJ for all visits in cases in which the adjudicated offense(s) includes any of the following: sex-related offenses, violent offenses that have resulted in personal injury or death, offenses committed with a weapon, or juveniles committed to state custody

Authorization for out-of-state travel is approved by the juvenile probation officer, parole officer or court designee supervising the juvenile in the sending state. The authorized Travel Permit is to be provided and received prior to the juvenile’s movement. Refer to ICJ Rule 5-102: Travel Permits)

Distribution:

  • For placement purposes, one copy in each of the three referral packets submitted to the Texas ICJ Office.
  • For visitation purposes, fax or email.
  • This form contains an instruction page. Please do not include this page when sending to Texas ICJ.


Victim Notification Supplement Form (revised 2/1/16)
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This supplemental form is used when the sending state will require the assistance of the supervising person in the receiving state to meet victim notification requirements.  The sending officer is to clearly document such in the initial referral packet using the Victim Notification Form. The Victim Notification Form is to include the specific information regarding what will be required and the timeframes for which it must be received.

Distribution: For placement purposes, one copy each in the three referral packets submitted to the Texas ICJ Office. This form contains an instruction page. Please do not include this instruction page when sending to Texas ICJ.


Supervision Forms


Form VIII: Home Evaluation Report (two pages) (revised 2/1/16)

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This required form is used by the receiving juvenile probation / parole officer to provide a detailed evaluation of the proposed placement. Only the receiving state’s ICJ Administrator or designee may authorize or deny supervision of a juvenile by that state after considering a recommendation by the investigating officer and within the parameters of the ICJ law and rules. Please review ICJ Rule 5-101: Authority to Accept/Deny Supervision for further information regarding when a receiving state must accept supervision.

Distribution: Three (3) copies to the Texas ICJ Office.


Form IX: Quarterly Progress, Violation, or Absconder Report (revised 2/1/16)

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The receiving state is to furnish written reports to the sending state on a quarterly basis using this form. Additional reports are to be sent in cases where there are concerns, violations, or a change in placement. (ICJ Rule 4-104.3.)

Distribution: Three (3) copies to the Texas ICJ Office.


Form X: Case Closure Notification Form (revised 2/1/16)

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This optional form is primarily used by the supervising juvenile probation / parole officer to advise of closing the case in specific circumstances as provided in ICJ Rule 5-104: Closure of Cases. The form is to be accompanied by a completed Form IX: Quarterly Progress Report.

 

Voluntary Return Procedure Forms


Juvenile Rights Form for Consent for Voluntary Return of Out of State Juvenile (revised 4/27/15)

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pdf icon PDF Format (Spanish/Español)
pdf icon PDF Format (English & Spanish/Inglés y Español)

This optional form provides rights that relate exclusively to the Interstate Compact for Juveniles, Article I, Voluntary Return Procedure, Texas Family Code, Chapter 60.010. These rights should not be considered a substitute for any other notice of rights required by law. Under the ICJ, the juvenile must be advised of his/her rights by the juvenile judge in the holding jurisdiction. When used, this form is to be signed and dated by the judge and sent to the holding state's ICJ Office with the Form III.

Distribution: Fax one copy to the Texas ICJ Office.


Form III:  Consent for Voluntary Return of Out of State Juvenile (revised 2/1/16)

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pdf icon PDF Format (Spanish/Español)
pdf icon PDF Format (English & Spanish/Inglés y Español)

This required form is used under Article I in cases when a juvenile is being held pending return to a home/demanding state.  If the juvenile consents to voluntarily return after his/her rights are read, the juvenile is to sign in the presence of a judge or authorized court master, referee, or hearing officer.  The court official signs to attest that the juvenile was advised of his/her rights and the voluntary return is appropriate and in the best interests of the juvenile.  In doing so, the judge orders the juvenile’s return.  If a guardian ad litem is appointed, that person is required to sign the form if in agreement with the juvenile’s voluntary consent.  The last section is completed with detailed information regarding the juvenile’s physical and clothing descriptions.

Distribution: Fax one copy to the Texas ICJ Office

Non-Voluntary Return of Out-of-State Juvenile Forms


Form A: Petition for Requisition to Return a Runaway Juvenile (revised 2/1/16)

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Distribution: This optional form is used when it becomes necessary to petition the home state's court to have a non-delinquent juvenile returned to the home state.


Form I: Requisition for Runaway Juvenile (revised 2/1/16)

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This required form is used under Article I when it becomes necessary for the court in the home state to take action in having a non-delinquent runaway juvenile returned. It is used only in cases where the juvenile refuses to return home or where there is some question of legality concerning the juvenile's return to his/her home state.

Distribution: Three requisitions packets with original signatures with the petition and certified supporting documents.

Petition for Hearing on Requisition for a Runaway Juvenile (Optional; revised 2/1/16)

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This optional form is used by the holding/asylum state’s ICJ office to petition the court in that state to hold a hearing on the requisition received from another state. The ICJ Office completes the form and forwards to the court in the holding/asylum county with the requisition packet (Forms I and A with certified supporting documents from the home state) along with the Order Setting Hearing form (see below). The Petition for Hearing on Requisition will require the court to assign a docket number and schedule a hearing.

Form II: Requisition for Escapee, Absconder or Juvenile Accused with Being Delinquent (revised 2/1/16)

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This required form is used under Article I for the requisition of an adjudicated delinquent escapee, probation or parole absconder or a juvenile accused of being delinquent.

Distribution: Three requisitions packets with original signatures with the petition and certified supporting documents.

Petition for Hearing on Requisition for Escapee, Absconder, or Accused Delinquent (revised 2/1/16)

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This optional form is used by the holding/asylum state’s ICJ office to petition the court in that state to hold a hearing on the Form II requisition received from another state. The ICJ Office completes the form and forwards to the court in the holding/asylum county with the requisition packet (Form II with certified supporting documents from the home/demanding state) along with the Order Setting Hearing form (see below). The Petition for Hearing on Requisition will require the court to assign a docket number and schedule a hearing.

Petition for Hearing Requisition for Escapee, Absconder, or Accused Delinquent(revised 2/1/16)

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This optional form is forwarded by the holding/asylum state’s ICJ Office along with the Petition for Hearing on Requisition for Escapee, Absconder, or Juvenile Accused Delinquent (see above) to the court in that state to schedule a hearing on the requisition from another state. Once the court assigns a docket number and schedules a hearing, this form is completed by the county/district clerk with the hearing date and time. The form is returned to the holding/asylum state’s ICJ Office and is then distributed to the home/demanding state’s ICJ Office.


Email ICJ comments to: txicj@tjjd.texas.gov

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