Michigan Department of Health and Human Services
IDENTIFYING INFORMATION
Case Name / Case ID
Child Name / Child Person ID
Worker Name / Organization / Phone Number
Email / Date / Placement Date
Gender / Birth Date / Race
Male / Female
Use only the section appropriate for child’s age and sex. File in Case record upon completion as outlined in FOM 903-9.
NOTE: This is not a mandatory wardrobe, only a guideline for help in determining basic clothing needs. Items and quantities may be modified to meet individual needs.
Sex / Age / Amount Allowed for Needed Clothing
Male Female / $
SUGGESTED
WARDROBE & QUANTITY / CHILD HAS / CHILD NEEDS / SUGGESTED
WARDROBE & QUANTITY / CHILD
HAS / CHILD NEEDS
CHILDREN 0 – 24 MONTHS OF AGE / CHILDREN 2 – 5 YEARS OF AGE
Outerwear / Outerwear
Daytime Outfits5 / Daytime Outfits5
Jacket1 / Jacket1
Snowsuit1 / Snowsuit1
Blankets – receiving6 / Bathing Suit1
Blanket – large1 / Underwear & Nightwear
Underwear & Nightwear / Training Pants or Underwear8
*Diapers48 / Undershirts8
Undershirts12 / Pajamas2
Pajamas4 / Footwear
Footwear / Socks8
Socks8 / Shoes1
Shoes1 / Sneakers1
Accessories / Boots1
Mittens1 / Accessories
Hat1 / Mittens1
Hat1
GIRLS 6 – 12 YEARS OF AGE / BOYS 6 – 12 YEARS OF AGE
Outerwear / Outerwear
Heavy Coat1 / Heavy Coat1
Raincoat1 / Jacket1
Jacket1 / Raincoat1
Sweaters1 / Sweater1
Dresses2 / Pants2
Skirts1 / Jeans3
Shirts4 / Dress Shirt1
Jeans3 / Shirts4
Pants2 / Tie1
Shorts2 / Shorts2
Bathing Suit1 / Bathing Suit1
Underwear & Nightwear / Underwear & Nightwear
Underwear8 / Underwear7
Bra2 / Undershirts7
Bathrobe1 / Pajamas2
Pajamas2 / Socks8
Footwear / Footwear
Socks6 / Dress Shoes1
Tights2 / Sneakers1
Dress Shoes1 / Boots1
Sneakers1 / Accessories
Boots1 / Gloves or Mittens1
Accessories / Hat1
Gloves or Mittens1 / Belt1
Hat1
*At Foster Parents’ discretion, one initial supply of diapers (one economy box) may be included. Ongoing cost of replacement is included in board and care rate.
SUGGESTEDWARDROBE & QUANTITY / CHILD HAS / CHILD NEEDS / SUGGESTED
WARDROBE & QUANTITY / CHILD
HAS / CHILD NEEDS
GIRLS 13 – 18 YEARS OF AGE / BOYS 13 – 18 YEARS OF AGE
Outerwear / Outerwear
Heavy Coat1 / Heavy Coat1
Raincoat1 / Jacket1
Jacket1 / Raincoat1
Sweaters2 / Sweater2
Dresses1 / Pants2
Skirts2 / Jeans2
Shirts6 / Dress Shirt1
Jeans2 / Shirt5
Pants2 / Tie1
Shorts2 / Shorts2
Bathing Suit1 / Bathing Suit1
Underwear & Nightwear / Underwear & Nightwear
Underwear8 / Underwear6
Bra3 / T-shirts6
Bathrobe1 / Pajamas1
Pajamas1 / Footwear
Footwear / Socks8
Socks5 / Dress Shoes1
Nylons2 / Sneakers1
Dress Shoes1 / Boots1
Sneakers1 / Accessories
Slippers1 / Gloves or Mittens1
Boots1 / Hat or Scarf1
Accessories / Belt1
Gloves or Mittens1
Hat or Scarf1
Belt1
Complete this section to inventory child’s non-clothing items. Note: These items are not part of the clothing allowance.
Toys:Electronics: (cell phone, electronic games/devices)
Personal mementos: (list items such as letters, pictures, family items)
Other: (suit cases, bags/diaper bags, purse, car seats, blankets, pillows, jewelry)
The Michigan Department of Health and Human Services (MDHHS) does not discriminate against any individual or group because of race, religion, age, national origin, color, height, weight, marital status, genetic information, sex, sexual orientation, gender identity or expression, political beliefs or disability.
DHS-3377 (Rev. 5-15) Previous edition obsolete. MS Word1