Date:

RE:	(child's name)

DCN:	(child's DCN)

Dear

The purpose of this letter is to provide 30 days notice of the closure, suspension, or modification of the adoption or guardianship subsidy agreement. This agreement is being closed, suspended, or modified on (date of closure) for the following reason:
Pursuant to 453.074.1 (4), if you disagree with this decision to deny, reduce or terminate benefits you have the right to request a hearing. The Application for Fair Hearing (CD-53) is enclosed. Your request for a hearing must be submitted within 30 days of the date of this letter. You must make the request in writing to the county office listed above. The local Children’s Division office will assist you in completing the application if you would like their assistance. Upon receipt of a written request CD will schedule an Administrative Review within ten (10) working days to attempt to resolve any issues prior to the Fair Hearing. Within one (1) working day of receipt of request, CD will forward the request to the Hearing’s Unit at Division of Legal Services (DLS). The DLS Hearings Unit will contact you regarding the hearing date. After the hearing, the director of the Children’s Division will issue a final decision. If you request a hearing: * You may represent yourself * An attorney may represent you * Other persons with knowledge of your situation may represent you * You have the right to present witnesses on your behalf * You have a right to question witnesses who appear at the request of the Children's Division Should you decide to withdraw your request for a Fair Hearing, complete and submit the enclosed Withdrawal for Fair Hearing (CD-54) to the local Children’s Division office. The local Children’s Division office will submit the Withdrawal for Fair Hearing to the DLS Hearing Unit within one (1) working day.

Thank you for the service you have provided to the Children’s Division and the level of commitment that you have provided through permanency for: (child's name). Your time of service is appreciated.

Sincerely,

Children’s Service Worker