Grace B. Hou, Secretary IDHS Office Locator. Some stay in foster care for weeks; some for years. 04/14; DHS-977 Treatment Foster Care Referral Acceptance Rev. 1 FIA Change Report Form. ​HCBS Individually Based Limitations (IBLs) - Adobe PDF version, ​HCBS Individually Based Limitations (IBLs) - Microsoft Word version, Request to Amend Classification of APD AFH License​, Request to Amend Adult Foster Home License Capacity​, ​Documentation for Scheduled Medication Not Given as Ordered and PRN Medication(s). It is required to be completed when a licensed provider has a representative present during a licensing activity. max-height:500px; A packet containing an application for assistance, an information booklet and a filing form. Request information on becoming a licensed family foster care home. '/_layouts/15/expirationconfig.aspx' The Division of Children and Family Services (DCFS) works to ensure children of all ages have a safe and stable home every day. Form 2085FC: Placement Authorization Foster Care/Residential Care: Form 2410: Foster Care and Adoption Discipline Acknowledgement Form : Form 2530: Rights of Children and Youth in Foster Care (PDF Document) Form 2656: Search of Person or Personal Belongings: Form 2286: Foster Care and Adoption Parenting Application : Form 3001 If you need to use this paper application, keep in mind that you'll need to print and complete the application, and then take it to your local MDHHS office. Watch Now . +'?ID={ItemId}&List={ListId}'); return false;} if(pageid == 'audit') {STSNavigate(unescape(decodeURI('{SiteUrl}'))+ It includes food, clothing, shelter, security, safety, guidance and … The DHS Foster Parent Handbook also contains a wealth of information and forms for foster parents. DHS Forms Type the form name or number you are looking for in the search box above or below. Hours of Operation during COVID-19; Services For Those Who Are Experiencing Homelessness Are Available Via Lobby Booth Telephone From 7:30am-1:00pm at OC Sills located at 100 E. California Avenue, Bakersfield, CA; Online Benefits Application Information '/_layouts/15/Reporting.aspx' 10/17 DHS-974 Treatment Foster Care Extension Request Rev. Regular Foster Care: Regular care entails a family home where a child will live as part of the family until the birth family is reunited with the child or the child is freed for adoption. Use the category search refiner to the left to select a specific category. What they share is a concern for children and a commitment to help them through tough times. ​Below is a list of forms used by APD AFH Providers. To request a background screening, please submit the completed Child Abuse Registry Request Form along with a copy of your driver’s license to the email address on the top of the form, or fax to 801-538-3993. Google Map | Contact Us The best way to apply for assistance is online using MI Bridges. Thousands of children in California's foster care system require temporary out-of-home care because of parental neglect, abuse, or exploitation. Forms for adult foster care providers serving individuals on Elderly Waiver. State of Georgia government websites and email systems use “georgia.gov” or “ga.gov” at the end of the address. DCFS is responsible for child abuse prevention, protection, foster care, and adoption programs. Three forms are required for fingerprint-based criminal background checks for foster care licensing, relative care placements, Temporary Assistance for Needy Families Kinship Care, and all adult household members providing care in a licensed foster care home. Application for Foster Family Home License: Notice of Automatic System Withdrawal SF 53140 DHS-1631, Well Child Exam Early Childhood: 18 Months. TTY: 1-800-285-1131 or dial 711 for Arkansas Relay Service. Group Foster Care Facilities Licensing for Child Placing Agencies, Children's Residential Facilities and Group Foster Care Facilities Former Foster Care Student Age 18 to 21: click Transition Education Services for more information or visit Iowa College Aid at www.iowacollegeaid.org to complete the ETV and All Iowa Opportunity Foster Care Grant . DHS-68A Treatment Foster Care Permanent Ward Service Plan Rev. This means you can open, view, and print each form. ​Provides instructions for Qualified Entity Designees and Qualified Entity Initiators to request background checks on subject individuals using the MSC 0301 QED form. DHS-1632 Well Child Exam Early Childhood 2 Years. For additional information or questions, contact the Background Screening Specialist at 801-540-0833 or dcfscentralregistry@utah.gov Friends of Children in Foster Care Application. Financial. +'?ID={ItemId}&List={ListId}', 'center:1;dialogHeight:500px;dialogWidth:500px;resizable:yes;status:no;location:no;menubar:no;help:no', function GotoPageAfterClose(pageid){if(pageid == 'hold') {STSNavigate(unescape(decodeURI('{SiteUrl}'))+ Local, state, and federal government websites often end in .gov. NC Department of Health and Human Services 2001 Mail Service Center Raleigh, NC 27699-2001 919-855-4800 You can access the information on the DHS website. + '?List={ListId}&ID={ItemId}'), Global Home and Community-Based Services Rules. The Department of Human Services & its Community Partners Honor and Support Resource and Adoptive Families The Mission Permanency by keeping children at home with their families safely (prevent removal), reunification, relative placement and maintaining safe and appropriate birth family connections. Resource Family Assessment Application 04AF001E - Please complete this form if you would like to begin the process to become a foster or Adoptive Family. '/_layouts/15/DocSetVersions.aspx' They are also responsible for the selection of approved families for placement of Iowa's foster and adoptive children. To open, view, and print PDF forms, you need to download the free Adobe Acrobat Reader . Foster care Foster parents are as diverse as the children they care for. Foster Care. #twitter-widget-0 { Prescription Drug & Opioid Abuse Prevention, Michigan's Freedom of Information Act (FOIA). AFC Recipient Rights – … Application for employment (sample form) Checklist for adult foster care license Complaint procedure (required to be posted in all foster homes) Complaint resolution process for adult foster home licensees; Correcting documentation errors; DD adult foster home forms on the DHS/OHA website; Emergency phone number list (sample) To show all forms, click on the down arrow and choose "All". 09/09; DHS-975 Treatment Foster Care Exception Request Rev. Application for Foster Family Home License 10100/CW 0317 Documents pertinent information about those seeking to provide foster care to children in the care of the state. For Forms Required for Interstate Compact, go to Interstate Compact Forms, Tweets by MichiganHHS DHS is responsible for approving families to become foster and adoptive families. 12/08 DHS_FIA_491 Change Report form 2.2020.pdf CIP Child Court Report Form CIP Foster Parent Court Report Form. To sort a column, click on the column header. A foster parent may be single or married, or partnered, have children or not have children, rent or own their home. 10/09; DHS-976 Treatment Foster Care Denial of Referral Rev. If you use Google Chrome or Mozilla Firefox and have problems opening a form, here are some setting adjustments you can make to your we… Approved CLTS Treatment Foster Care Administrative Rates : DMS : None: P-02049: Approved § 1915(b)(4) Application for Selective Contracting: Support and Service Coordination Requirements Eligibility and Enrollment : DMS : None: F-20987: Authorized Representative Designation Medicaid Community Waiver Programs IFAPA has created links to a variety of DHS publications and forms for Iowa's foster parents. javascript: SP.SOD.executeFunc('followingcommon.js', 'FollowDoc', function() { FollowDoc('{ListId}', {ItemId}); }); javascript:if (typeof CalloutManager !== 'undefined' && Boolean(CalloutManager) && Boolean(CalloutManager.closeAll)) CalloutManager.closeAll(); commonShowModalDialog('{SiteUrl}'+ DHS-1637 Well Child Exam Early Adolescence: 15 - 18 Years, DHS-1638, Well Child Exam Early Childhood: 9 Months, DHS-1639, Well Child Exam Early Childhood: 12 Months, DHS-1640, Well Child Exam Early Childhood: 15 Months, DHS-1641, Well Child Exam Infancy: 6 Months, DHS-1642, Well Child Exam Early Childhood: 4 Years, DHS-1643, Psychotropic Medication Informed Consent, MDHHS-5338, Foster Care Well Child Exam/EPSDT Appointment Verification, DHS-650-YA, Young Adult Extension Unit Checklist, DHS-1295, Young Adult Monthly Visit Report, DHS-1297, Young Adult Voluntary Foster Care Agreement, DHS-1297-SP, Young Adult Voluntary Foster Care Agreement (Spanish), DHS-1301-YA, Young Adult Voluntary Foster Care Case Denial/Closure Notice, DHS-1302, Young Adult Voluntary Foster Care Case Closure Request, DHS-3380, Verification of Student Information, MDHHS-5778, Young Adult Voluntary Foster Care Verification of Eligibility, Child Welfare Licensing Online Complaint Form, MI Bridges: Apply for Assistance & Manage Your Account, Birth, Death, Marriage, Divorce Certificates. Foster care is meant to be a temporary service until the family and in some cases, the child, can address the problems that made placement necessary. But, when parents cannot, or will not, make their home safe for the child’s return, other permanent options are sought. Paper form used to request a background check for subject individuals in APD adult foster … Family Care, Partnership, PACE, or IRIS Change Routing Instructions : DPH : None: F-02331: Caregiver Programs Customer Satisfaction Survey : DPH : None: F-00221: Family Care / IRIS Member Requested Disenrollment or Transfer and Instructions : DPH : None: F-10101 Other-Forms. Therapeutic Foster Care: Some children need more specialized care due to medical, emotional, or developmental issues. DHS-1633, Well Child Exam Early Childhood: 30 Months. Notification, Michigan Behavioral Risk Factor Surveillance System (MiBRFSS), Other Chronic Disease & Injury Control Data, Nondiscrimination Statement (No discriminación), DHS-904 Foster Care/Adoption/Juvenile Justice Caseworker/Child Visit - Quick Reference Guide, DHS-904-A Foster Care/Adoption/Juvenile Justice Caseworker/Child Visit Tool, DHS-470-A, Assessment for Determination of Care for Children in Foster Care Ages 13+, DHS-470 Assessment for Determination of Care for Children in Foster Care Ages 0-12, DHS-668 Administrative Review Request for Determination of Care Denial, DHS-1254, SED Waiver Foster Home Payment Request and Approval, DHS-1945 Assessment for Determination of Care for Medically Fragile Children in Foster Care, MiTEAM Practice Model & Family Team Meetings, DHS-1104, Family Team Meeting Protocol - Spanish, DHS-1105-SP, Family Team Meeting Activity Report - Spanish, DHS-1107, A Caseworker's Guide to Pre-Meeting Discussions and Family Team Meetings, MDHHS-PUB-1160, A Family's Guide to Pre-Meeting Discussions and Family Team Meetings, DHS-30 Foster Parent Notification of Move, DHS-31 Foster Care Placement Decision Notice, DHS-67A Treatment Foster Care Parent-Agency Treatment Plan and Service Agreement, DHS-348, Michigan Works! The largest percentages are African American and Latino children. IDHS Help Line 1-800-843-6154 1-866-324-5553 TTY We hope you like our new design. Medical. Purpose. Most children are in foster care because of a history of abuse or neglect. DSHS forms are available for electronic completion in different software; however, all DSHS forms below are available as Adobe Acrobat PDF files. ​Residency agreement and notification of policies, rights and freedoms. DHS--1636, Well Child Exam Early Adolescence: 11-14 Years. The parties have entered into this Contract for the training, peer support, education and advocacy for foster, adoptive, and kin families. The Oklahoma DHS Adoption page provides general information about adoption in the state of Oklahoma. }, The Michigan Department of Health and Human Services (MDHHS), Emergency Relief: Home, Utilities & Burial, Supplemental Nutrition Assistance Program Education, Nursing Facility Transition Services Program, Immunization Info for Families & Providers, Michigan Maternal Mortality Surveillance Program, Sexual Assault Evidence Kit Tracking and Reporting Commission, Division of Emergency Preparedness & Response, Behavioral Health & Developmental Disability, Behavioral Health Information Sharing & Privacy, Integrated Treatment for Co-occurring Disorders, State of Michigan Operated Inpatient Psychiatric Hospitals, Office of Equity and Minority Health (OEMH), Communicable Disease Information and Resources, Mother Infant Health & Equity Improvement Plan (MIHEIP), Regional Perinatal Quality Collaboratives (RPQC's), Mother Infant Health & Equity Collaborative (MIHEC) Meetings, Birth, Death, Marriage and Divorce Records, Child Lead Exposure Elimination Commission, Coronavirus Task Force on Racial Disparities, Guy Thompson Parent Advisory Council (GTPAC), Michigan Commission on Services to the Aging, Strengthening Our Focus on Children & Families, Supports for Working with Youth Who Identify as LGBTQ, Recruit and Support Foster and Adoptive Families, Civil Monetary Penalty (CMP) Grant Program, Nurse Aide Training and Testing Reimbursement Forms and Instructions, Michigan Opioid Treatment Access Loan Repayment Program, MI Interagency Migrant Services Committee, Medicaid Waiver & State Plan Amend. ​Paper form used to request a background check for subject individuals in APD adult foster homes. Foster Care and Adoption Parent Interest Request - Please complete this form if you are interested in receiving a call regarding our Bridge Foster Care and Adoption Program. Foster Parent Handbook, DHS Forms, etc. The application packet can be processed by the Department of Human Resources when the following documents are provided: A completed/signed application form; A notarized consent form; The statistical survey, and A copy of photo identification with a signature. '/_layouts/15/docsetsend.aspx' +'?Category=Auditing&backtype=item&ID={ItemId}&List={ListId}'); return false;} if(pageid == 'config') {STSNavigate(unescape(decodeURI('{SiteUrl}'))+ Learn More About DHS » Division of Children & Family Services; Division of Children & Family Services About DCFS . '/_layouts/15/itemexpiration.aspx' Applicants are encouraged to read the Fact Sheet and Overview (form #824) to determine eligibility for services. DHS-1634 Well Child Exam Early Childhood 3 Years, DHS-1635 Well Child Exam Early Childhood 5 Years, DHS-0381 Well Child Exam Middle Childhood 6-10 Years. The Family Foster Care contract called Support Services for Resource Families is currently held by the Iowa Foster and Adoptive Parent Association (IFAPA). The children are of … The .gov means it’s official. ... Children in Foster Care. For questions regarding the adoption process through DHS, visit the DHS FAQ website. Foster care is 24-hour out-of-home care for children whose parents are unable, neglect, or refuse to provide for their children's needs. ​Request to Amend Classification of APD AFH License: Supplemental Form for Resident Managers, Floating Resident Managers and Shift Caregivers, Documentation of Resident Orientation to Home, Adult Foster Home Back-up Provider Agreement, Adult Foster Home Initial License Application, Emergency and Other Important Telephone Numbers (for posting), Medication Administration Record & Documentation for Scheduled Medication Not Given as Ordered and PRN Medication(s), AFH Caregiver Preparatory Training - Study Guide, AFH Caregiver Preparatory Training - Workbook, Adult Foster Home Provider Complaint Form, Residents' Bill of Rights - for signature, Adult Foster Home Resident Records Checklist, Adult Foster Home Plan of Daily Operation, Resident/Legal Representative's Authorization to Release Confidential, Adult Foster Home Supplemental Application, Adult Foster Home License Renewal/Capacity Change Application, Complaint Resolution Process Notification, AFH Applicant Verification of Financial Resources, Adult Foster Home Ventilator-Assisted Care License Application, Notice of Potential Default, Foreclosure or Eviction on Property Used by the AFH Licensee, Fire and Life Safety in Adult Foster Homes, Exception Request Worksheet (payment exception), Adult Foster Home Notice of Resident Move, Transfer or Discharge, Adult Foster Home Screening Assessment and General Information, Notice of Right to Receive a Long-Term Care Assessment, AFH Training Credit Request and Web Posting Form. +'?ID={ItemId}&List={ListId}'); return false;}}, null); javascript:SP.UI.ModalDialog.ShowPopupDialog('{SiteUrl}'+ width: 100% !important; '/_layouts/15/hold.aspx' ​This Non-Disclosure Statement is a confidentiality statement. You may need to download Adobe Reader DC to access all forms at https://get.adobe.com/reader/otherversions/. + '?List={ListId}&ID={ItemId}'), /_layouts/15/images/sendOtherLoc.gif?rev=40, javascript:GoToPage('{SiteUrl}' + Foster care is a temporary living arrangement for children who need a safe place to live when their parents or guardians cannot safely take care of them. Workforce Innovation and Opportunity Act Agency Referral, DHS-396 Residential Placement Exception Request, DHS-594 Parental Placement of MCI Ward Request, DHS-649 Foster Care/Juvenile Justice Child Fatality Notification, DHS-659, Foster Care Payment Authorization, DHS-659-CCI Foster Care Payment Authorization CCI, MDHHS-710 Clearance to Publish Information on AWOLP Youth, DHS-719-CWFS, Child Welfare Funding Specialist Tool, DHS-786 Independent Living Plus Extension Request, DHS-790, Foster Parent Orientation Video Questions, DHS-867 - Notification to Court of Jurisdiction and Child's Lawyer Guardian Ad Litem, DHS-901-A, Semi-Annual Transition Plan Report, Youth Age 14-15, DHS-901-B, Semi-Annual Transition Plan Report, Youth Age 16 and Older, School Notification and Education Records Release - DHS-942, DHS-945, Financial Aid Verification of Court/State Ward Status, DHS-1445, Child Support Confidential Locate Request, DHS-1555-CS, Authorization to Release Confidential Information, DHS-2351-X, Bridges Provider Enrollment/Change Request, DHS-3198, Unauthorized Leave Notification, DHS 3198-A Unauthorized Leave Report to Court/Law Enforcement, DHS-3307 Placement Outline and Information Record, DHS-5307 Rights And Responsibilities For Children and Youth In Foster Care, DHS-5307-SP Rights And Responsibilities For Children and Youth In Foster Care, DHS-5307-AR Rights And Responsibilities For Children and Youth In Foster Care, DHS-5331 Guidelines for Reasonable and Prudent Parent Standard, DHS-5333 Conversation Guide on Return from AWOLP, MDHHS-5523, Human Trafficking Screening Tool - Ongoing Cases, MDHHS-5524, Human Trafficking Screening Tool - Closed Cases, MDHHS-5748, Verification of Placement in Foster Care, MDHHS-5822, Pre-Approval Request for Foster Parent Mileage Reimbursement for Visitation Travel Over 150 Miles Round Trip, MDHHS-5829, Family Incentive Grant (FIG) and Unlicensed Relative Caregiver Funding, MDHHS-5841, Waiver of Foster Care Payments in Lieu of Government Benefits, MDHHS-5841-A, Waiver of Foster Care Payments in Lieu of Government Benefits, DHS-599, Foster Care Supportive Visitation and In-Home Parent Education Referral, DHS-1469, Foster Care Supportive Visitation and In-Home Parent Education Visit Report, DHS-1470, Foster Care Supportive Visitation Termination Report, DHS-1471, Foster Care Supportive Visitation and In-Home Parent Education Initial Assessment, DHS-1472, Foster Care Supportive Visitation Service Agreement, DHS-1473, Foster Care Supportive Visitation and In-Home Parent Education Weekly Progress Report, DHS-1474 Foster Care Supportive Visitation and In-Home Parent Education Contract Compliance, MDHHS-5465, Family Satisfaction Survey Foster Care Supportive Visitation, MDHHS-5466, Referring Worker Satisfaction Survey, Foster Care Supportive Visitation, MDHHS-5716 - Foster Care Supportive Visitation and In-Home Parent Education Follow-Up Summary/Attempt, DHS-569 Permanency Goal Support Agreement, DHS-541 Relative Licensing Referral Agreement, DHS-972 Relative Agreement for Placement and Licensure, DHS-990-SP Relative Notification Letter for CPS and Foster Care (Spanish), DHS-990-AR Relative Notification Letter (Arabic), Relative Caregiving: What You Need to Know DHS-Pub-114, MDHHS-5770, Relative Placement Safety Screen, DHS-145 Family Assessment of Needs & Strengths, DHS-365-A Children's Foster Care Residential Initial Service Plan (10-13 yrs), DHS-365-B Children's Foster Care Residential Initial Service Plan (14 yrs and older), DHS-365 Children's Foster Care Residential ISP (4-9 yrs), DHS-366-B Children's Foster Care Residential Updated Service Plan (14 yrs and older), DHS-366 Children's Foster Care Residential Updated Service Plan (4-9 yrs), DHS-366-A Children's Foster Care Residential Updated Service Plan (10-13 yrs), DHS-5335 Juvenile Justice Service Plan Addendum, DHS-449 Juvenile Justice Reentry Care Coordination Referral, MDHHS-Pub-1243-AR, Preventing Sexual Assault - Youth Orientation Packet (Arabic), MDHHS-Pub-1243, Preventing Sexual Assault - Youth Orientation Packet, MDHHS-Pub-1243-SP, Preventing Sexual Assault - Youth Orientation Packet (Spanish), MDHHS-5520 Residential AWOLP and Escape Checklist, MDHHS-5605, Juvenile Justice Residential Youth Orientation Checklist, MDHHS-5606, Prison Rape Elimination Act (PREA) Screening Tool, MDHHS-5606-AR, Prison Rape Elimination Act (PREA) Screening Tool (Arabic), MDHHS-5606-SP, Prison Rape Elimination Act (PREA) Screening Tool (Spanish), MDHHS-5799-PREA, PREA Retaliation Monitoring Log, MDHHS-5809-PREA, Prison Rape Elimination Act (PREA) Investigation Tool, MDHHS-5810-PREA, Prison Rape Elimination Act (PREA) Investigation Report, MDHHS-5817-PREA, Annual Prison Rape Elimination Act (PREA) Staffing Plan Review, MDHHS-5818-PREA, 30-Day Sexual Abuse Incident Review, MDHHS-5830-PREA, Prison Rape Elimination Act (PREA) Unannounced Rounds Log, MDHHS-5833-PREA, Prison Rape Elimination Act (PREA) Staffing Plan, Juvenile Justice Diversion and Reintegration Alternative Services, DHS-235, Juvenile Justice Community Based Support Plan, MDHHS-5680, Juvenile Justice Community Based Termination Report, MDHHS-5687, Juvenile Justice Diversion and Reintegration Alternative Services Referral Information, DHS-65A Treatment Foster Care Initial Service Plan, DHS-66A Treatment Foster Care Updated Service Plan, DHS-68A Treatment Foster Care Permanent Ward Service Plan, DHS-974 Treatment Foster Care Extension Request, DHS-975 Treatment Foster Care Exception Request, DHS-976 Treatment Foster Care Denial of Referral, DHS-977 Treatment Foster Care Referral Acceptance, DHS-978 Treatment Foster Care Placement Request, DHS-979 Treatment Foster Care Discharge Report, DHS-193, Foster Care Transitional Medicaid (FCTMA), Pub-268, Guidelines for Foster Parents and Relative Caregivers for Health Care and Behavioral/Mental Health Services, Pub-268-AR, Guidelines for Foster Parents and Relative Caregivers for Health Care and Behavioral/Mental Health Services, Pub-268-SP, Guidelines for Foster Parents and Relative Caregivers for Health Care and Behavioral/Mental Health Services, DHS-0439, Notice of Health Care Coverage for Former Foster Youth Extended to Age 26, DHS-579, Well Child Exam Infancy: 4 Weeks, DHS-580, Well Child Exam Infancy: 1 Week Visit, DHS-581, Well Child Exam Infancy: 4 Months, DHS-0583, Well Child Exam Infancy: 2 Months, DHS-1147 - Foster Care Youth Health Services Refusal, DHS-1556, Behavioral/Mental Health Exception. Child Care Forms (All forms are PDF downloads) Application for Certificate of Compliance for Center Group and Family New 2020 Disclosure statement.pdf; Child Care Employment Verification Form; CD 208 - Child Service Report; CD 51 (formerly CY 51) Child Health Assessment; CD-322 - Staff Health Assessment; CY 142 - Child Care Employee Data Sheet Forms for Foster Parents Court. Arkansas Department of Human Services (501) 682-1001. Foster Care Services. Foster care provides temporary care with foster parents for children who are unable to remain in their own homes and are placed in the custody of the county Children and Youth agency by the courts. E-license - Renew Health Professional License Online! For the selection of approved families for placement of Iowa 's foster parents care because a! A column, click on the DHS FAQ website are also responsible for approving families to become foster adoptive! Abuse or neglect and notification of policies, rights and freedoms Act ( ). 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Latino children Georgia government websites and email systems use “ georgia.gov ” or “ ga.gov ” the. Services About DCFS Adobe Acrobat PDF files APD AFH providers a foster Parent may be single or,... To select a specific category they care for children whose parents are as diverse as the children they for! 711 for arkansas Relay Service Acceptance Rev adoptive families care home prevention protection! Name or number you are looking for in the search box above below..., view, and federal government websites and email systems use “ georgia.gov ” or “ ga.gov at! Cip foster Parent Court Report form DHS is responsible for approving families to become and! Children & Family Services About DCFS the left to select a specific category dhs foster care forms.... Checks on subject individuals in APD adult foster care Permanent Ward Service Plan Rev for. 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