The Legal Innovation & Technology Lab's Form Explorer ^Beta @ Suffolk Law School Last updated 2023-04-02

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Here is the text we could read:

SUPERIOR COURT OF CALIFORNIA, COUNTY OF

STREET ADDRESS:

MAILING ADDRESS:

CITY AND ZIP CODE:

BRANCH NAME:

CHILD'S NAME:

HEARING DATE AND TIME:

DEPARTMENT: (JUVENILE, FAMILY, OR PROBATE)

ICWA-100

FOR COURT USE ONLY

TRIBAL INFORMATION FORM

CASE NUMBER:

To the representative of the Indian Child's Tribe: You may use this optional form to provide written information to the court. Please
type or print clearly in ink. Check item 10 if you want to attach additional information on a separate sheet either because you need
more space to respond to any section on this form or have other information that you wish to share with the court. You must submit
this form ahead of the hearing so that all parties are aware of the information in this form. You can file this form in person, by mail or
by fax. If you are filing in person, submit the original and eight copies of the form to the court clerk's office at least five calendar days
before the hearing. If you are filing by mail, you must send the original and eight copies to the court clerk's office at least seven days
before the hearing. You may also submit this form by fax. Phone the court to ask for the correct fax number. Be aware that other
individuals involved in the case have access to this information. Be aware that any written information provided, including this form,
may not be admitted as evidence if the court determines that it is not admissible by law.

c. Child's age:

1. Child's Information

a. Child's full name:
b. Child's date of birth:

2. Tribal Information

a. Name of tribe:

Address:

Telephone:

Fax:

Email:

b. Name of person completing this form:

c. Name(s) of persons authorized to represent the tribe in this case:

d. Tribal representative's contact information

e. Duplicate notices, reports, orders, and other documents concerning this case may may not be served by

email at the above address.

3. Tribal Intervention (please check either a. or b.)

The Indian child's tribe: or in the case.

has intervened

is intervening

The tribe requests that this form be admitted by the court under California Rules of Court, rule 5.534(e)(2)(E).

4. Hearing Information

This Tribal Information Form is submitted for the (insert type of hearing):
scheduled for (insert date of hearing): in department
If you indicate in items 4 through 7 that the tribe has not been consulted on any issue, please explain in the "Further Comments"
section the particulars of communication or attempts at communication with the agency or petitioner throughout this time period.

5. Communication

Further comments:

In the last six months, or since the last hearing, there been ongoing consultation and
communication between the agency or other petitioner and the tribe.

has not

has

Form Approved for Optional Use
Judicial Council of California
ICWA-100 [New January 1, 2021]

TRIBAL INFORMATION FORM

Page 1 of 3

Cal. Rules of Court, rule 5.534(e)

CHILD'S NAME:

CASE NUMBER:

ICWA-100

6. Case Planning, Services, and Active Efforts

In the last six months, or since the last hearing, the tribe been consulted on the
appropriate services to be provided to the parent(s), legal guardian(s), or Indian custodian(s), and the child.

has not

has

The tribe submits the following information and comments with regard to case planning and services for the child and
parent(s), legal guardian(s), or Indian custodian(s), and efforts to provide remedial services and rehabilitative programs
designed to prevent the breakup of the Indian family.

The tribe recommends that the following programs and services be integrated into the parents' and child's case plan:

The tribe has the following input on the child's adjustment to the child's living arrangements:

The tribe has the following input on upcoming tribal, cultural, or social events that the tribe recommends the child attend:

The tribe has the following input on the child's well-being:

The tribe has the following input on the child's educational status:

The tribe has the following input on the child's social development:

The tribe has the following observations regarding visitation:

The tribe has the following input on the needs of the parent(s) or child:

The tribe has the following other recommendations:

Further comments:

Placement (if the child is in out-of-home placement)

The tribe been consulted on the child's placement.

has not

has

The tribe know where the child is currently placed.

does not

does

The tribe agree with the child's current placement.

does not

does

The tribe requests that the child be placed with (insert name): .
This placement is preferable because: .
Further comments:

ICWA-100 [New January 1, 2021]

TRIBAL INFORMATION FORM

Page 2 of 3

CHILD'S NAME:

CASE NUMBER:

ICWA-100

Permanency Planning (if the child is in out-of-home placement)

a. The tribe has has not been consulted regarding the appropriate permanent plan for the child should

reunification with the parent(s), legal guardian(s), or Indian custodian(s) fail.

b. The agency has has not discussed with the tribe tribal customary adoption as a permanency option should

reunification with the parent(s), legal guardian(s), or Indian custodian(s) fail.

10.

If you need more space to respond to any section on this form or have other information that you wish to share with the court,
please check this box and attach additional pages.

Further comments:

9. Other information:

Number of pages attached:

Date:

I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

(TYPE OR PRINT NAME)

(SIGNATURE OF TRIBAL REPRESENTATIVE WHO HAS
COMPLETED THIS FORM)

ICWA-100 [New January 1, 2021]

TRIBAL INFORMATION FORM

Page 3 of 3

Tribal Information Form

This info page is part of the LIT Lab's Form Explorer project. It is not associated with the California state courts. To learn more about the project, check out our about page.

Downloads: You can download both the original form (last checked 2023-03) and the machine-processed form with normalized data fields.

About This Form:

Sourced from selfhelp.courts.ca.gov (2023-03)
Page(s): 3
Fields(s): 89
Average fields per page: 29
Reading Level: Grade 8
LIST Grouping(s): Unknown

Use our Rate My PDF tool to learn more. Go beyond the above insights and learn more about this or any pdf form at RateMyPDF.com, includes: counts of difficult words used, passive voice decetion, and suggestions for how to make the form more usable.

Identified Data Fields:

We have done our best to automaticly identify and name form fields according to our naming conventions. When possible, we've used names tied to our question library. See e.g., user1_name. If we think we've found a match to a question in our library, it is highlighted in green. Novel names are auto generated. So, you will probably need to edit some of them if you're trying to stick to the convention.

Here are the fields we could identify.

icw_page_case_number_ft was ICWA-100[0].Page1[0].CaseNumber[0].CaseNumber_ft[0] (0.49 conf)
icw_page_court_info_crt_county was ICWA-100[0].Page1[0].CourtInfo[0].CrtCounty[0] (0.38 conf)
icw_page_court_info_crt_street was ICWA-100[0].Page1[0].CourtInfo[0].CrtStreet[0] (0.38 conf)
page_court_info_crt_mailing_add was ICWA-100[0].Page1[0].CourtInfo[0].CrtMailingAdd[0] (0.43 conf)
page_court_info_crt_city_zip was ICWA-100[0].Page1[0].CourtInfo[0].CrtCityZip[0] (0.43 conf)
icw_page_court_info_crt_branch was ICWA-100[0].Page1[0].CourtInfo[0].CrtBranch[0] (0.38 conf)
page_header_title_party_name_child was ICWA-100[0].Page1[0].CRP1Header[0].TitlePartyName[0].ChildName[0] (0.38 conf)
page_title_party_name_date_time was ICWA-100[0].Page1[0].CRP1Header[0].TitlePartyName[0].HrngDateTime[0] (0.40 conf)
page_title_party_name_department was ICWA-100[0].Page1[0].CRP1Header[0].TitlePartyName[0].Department[0] (0.33 conf)
icw_page_list_li_child_name was ICWA-100[0].Page1[0].List1[0].Li1[0].ChildName[0] (0.31 conf)
icw_page_list_li_fill_text__1 was ICWA-100[0].Page1[0].List1[0].Li2[0].FillText1[0] (0.36 conf)
icw_page_list_li_fill_text__2 was ICWA-100[0].Page1[0].List1[0].Li3[0].FillText1[0] (0.36 conf)
icw_page_list_li_text_field__1 was ICWA-100[0].Page1[0].List2[0].Li1[0].TextField[0] (0.34 conf)
icw_page_list_li_text_field__2 was ICWA-100[0].Page1[0].List2[0].Li2[0].TextField[0] (0.34 conf)
icw_page_list_li_text_field__3 was ICWA-100[0].Page1[0].List2[0].Li3[0].TextField[0] (0.34 conf)
icw_page_list_li_text_field__4 was ICWA-100[0].Page1[0].List2[0].Li4[0].TextField1[0] (0.34 conf)
icw_page_list_li_text_field__5 was ICWA-100[0].Page1[0].List2[0].Li4[0].TextField2[0] (0.34 conf)
icw_page_list_li_text_field__6 was ICWA-100[0].Page1[0].List2[0].Li4[0].TextField3[0] (0.34 conf)
icw_page_list_li_text_field__7 was ICWA-100[0].Page1[0].List2[0].Li4[0].TextField4[0] (0.34 conf)
icw_page_list_li_may_cb__1 was ICWA-100[0].Page1[0].List2[0].Li5[0].May_cb[0] (0.39 conf)
icw_page_list_li_may_cb__2 was ICWA-100[0].Page1[0].List2[0].Li5[0].May_cb[1] (0.39 conf)
icw_page_list_li_check_box_ab__1 was ICWA-100[0].Page1[0].List3[0].Li1[0].CheckBox_ab[0] (0.37 conf)
icw_page_list_li_interven_cb__1 was ICWA-100[0].Page1[0].List3[0].Li1[0].interven_cb[0] (0.36 conf)
icw_page_list_li_interven_cb__2 was ICWA-100[0].Page1[0].List3[0].Li1[0].interven_cb[1] (0.36 conf)
icw_page_list_li_check_box_ab__2 was ICWA-100[0].Page1[0].List3[0].Li2[0].CheckBox_ab[0] (0.37 conf)
icw_page_list_li_text_field__8 was ICWA-100[0].Page1[0].List4[0].Li1[0].TextField1[0] (0.34 conf)
icw_page_list_li_date_field was ICWA-100[0].Page1[0].List4[0].Li1[0].DateField1[0] (0.40 conf)
icw_page_list_li_text_field__9 was ICWA-100[0].Page1[0].List4[0].Li1[0].TextField2[0] (0.34 conf)
icw_page_list_li_area_check_box__1 was ICWA-100[0].Page1[0].List5[0].Li1[0].#area[0].CheckBox1[0] (0.35 conf)
icw_page_list_li_area_cb__1 was ICWA-100[0].Page1[0].List5[0].Li1[0].#area[1].has_cb[0] (0.36 conf)
icw_page_list_li_area_cb__2 was ICWA-100[0].Page1[0].List5[0].Li1[0].#area[2].has_cb[1] (0.36 conf)
page_list_li_area_fur_comm was ICWA-100[0].Page1[0].List5[0].Li2[0].#area[0].FurComm_cb[0] (0.37 conf)
icw_page_list_li_text_field__10 was ICWA-100[0].Page1[0].List5[0].Li2[0].TextField[0] (0.34 conf)
page_title_party_name_child__1 was ICWA-100[0].Page2[0].pxCaption[0].TitlePartyName[0].ChildName[0] (0.33 conf)
icw_page_px_caption_case_number_ft__1 was ICWA-100[0].Page2[0].pxCaption[0].CaseNumber[0].CaseNumber_ft[0] (0.31 conf)
icw_page_list_li_area_check_box__2 was ICWA-100[0].Page2[0].List6[0].Li3[0].#area[0].CheckBox1[0] (0.35 conf)
icw_page_list_li_text_field__11 was ICWA-100[0].Page2[0].List6[0].Li3[0].TextField[0] (0.34 conf)
icw_page_list_li_area_check_box__3 was ICWA-100[0].Page2[0].List6[0].Li2[0].#area[0].CheckBox1[0] (0.35 conf)
icw_page_list_li_text_field__12 was ICWA-100[0].Page2[0].List6[0].Li2[0].TextField[0] (0.34 conf)
icw_page_list_li_area_check_box__4 was ICWA-100[0].Page2[0].List6[0].Li4[0].#area[0].CheckBox1[0] (0.35 conf)
icw_page_list_li_text_field__13 was ICWA-100[0].Page2[0].List6[0].Li4[0].TextField[0] (0.34 conf)
icw_page_list_li_area_check_box__5 was ICWA-100[0].Page2[0].List6[0].Li5[0].#area[0].CheckBox1[0] (0.35 conf)
icw_page_list_li_text_field__14 was ICWA-100[0].Page2[0].List6[0].Li5[0].TextField[0] (0.34 conf)
icw_page_list_li_area_check_box__6 was ICWA-100[0].Page2[0].List6[0].Li6[0].#area[0].CheckBox1[0] (0.35 conf)
icw_page_list_li_text_field__15 was ICWA-100[0].Page2[0].List6[0].Li6[0].TextField[0] (0.34 conf)
icw_page_list_li_area_check_box__7 was ICWA-100[0].Page2[0].List6[0].Li7[0].#area[0].CheckBox1[0] (0.35 conf)
icw_page_list_li_text_field__16 was ICWA-100[0].Page2[0].List6[0].Li7[0].TextField[0] (0.34 conf)
icw_page_list_li_area_check_box__8 was ICWA-100[0].Page2[0].List6[0].Li8[0].#area[0].CheckBox1[0] (0.35 conf)
icw_page_list_li_text_field__17 was ICWA-100[0].Page2[0].List6[0].Li8[0].TextField[0] (0.34 conf)
icw_page_list_li_area_check_box__9 was ICWA-100[0].Page2[0].List6[0].Li9[0].#area[0].CheckBox1[0] (0.35 conf)
icw_page_list_li_text_field__18 was ICWA-100[0].Page2[0].List6[0].Li9[0].TextField[0] (0.34 conf)
icw_page_list_li_area_check_box__10 was ICWA-100[0].Page2[0].List6[0].Li10[0].#area[0].CheckBox1[0] (0.35 conf)
icw_page_list_li_text_field__19 was ICWA-100[0].Page2[0].List6[0].Li10[0].TextField[0] (0.34 conf)
icw_page_list_li_area_check_box__11 was ICWA-100[0].Page2[0].List6[0].Li11[0].#area[0].CheckBox1[0] (0.35 conf)
icw_page_list_li_text_field__20 was ICWA-100[0].Page2[0].List6[0].Li11[0].TextField[0] (0.34 conf)
icw_page_list_li_area_check_box__12 was ICWA-100[0].Page2[0].List6[0].Li12[0].#area[0].checkBox1[0] (0.36 conf)
icw_page_list_li_text_field__21 was ICWA-100[0].Page2[0].List6[0].Li12[0].TextField[0] (0.34 conf)
icw_page_list_li_area_check_box__13 was ICWA-100[0].Page2[0].List6[0].Li1[0].#area[0].CheckBox1[0] (0.35 conf)
icw_page_list_li_area_cb__3 was ICWA-100[0].Page2[0].List6[0].Li1[0].#area[1].has6_cb[0] (0.36 conf)
icw_page_list_li_area_cb__4 was ICWA-100[0].Page2[0].List6[0].Li1[0].#area[2].has6_cb[1] (0.36 conf)
icw_page_list_area_checkbox was ICWA-100[0].Page2[0].List7[0].#area[0].Checkbox1[0] (0.36 conf)
icw_page_list_li_area_check_box__14 was ICWA-100[0].Page2[0].List7[0].Li1[0].#area[0].CheckBox1[0] (0.35 conf)
icw_page_list_li_area_cb__5 was ICWA-100[0].Page2[0].List7[0].Li1[0].#area[1].has7a_cb[0] (0.36 conf)
icw_page_list_li_area_cb__6 was ICWA-100[0].Page2[0].List7[0].Li1[0].#area[2].has7a_cb[1] (0.36 conf)
icw_page_list_li_area_check_box__15 was ICWA-100[0].Page2[0].List7[0].Li2[0].#area[0].CheckBox1[0] (0.35 conf)
icw_page_list_li_area_b_cb__1 was ICWA-100[0].Page2[0].List7[0].Li2[0].#area[1].does7b_cb[0] (0.36 conf)
icw_page_list_li_area_b_cb__2 was ICWA-100[0].Page2[0].List7[0].Li2[0].#area[2].does7b_cb[1] (0.36 conf)
icw_page_list_li_area_check_box__16 was ICWA-100[0].Page2[0].List7[0].Li3[0].#area[0].CheckBox1[0] (0.35 conf)
icw_page_list_li_area_c_cb__1 was ICWA-100[0].Page2[0].List7[0].Li3[0].#area[1].does7c_cb[0] (0.36 conf)
icw_page_list_li_area_c_cb__2 was ICWA-100[0].Page2[0].List7[0].Li3[0].#area[2].does7c_cb[1] (0.36 conf)
icw_page_list_li_check_box was ICWA-100[0].Page2[0].List7[0].Li4[0].CheckBox1[0] (0.35 conf)
icw_page_list_li_text_field__22 was ICWA-100[0].Page2[0].List7[0].Li4[0].TextField1[0] (0.34 conf)
icw_page_list_li_text_field__23 was ICWA-100[0].Page2[0].List7[0].Li4[0].TextField2[0] (0.34 conf)
page_list_li_area_check_cb__1 was ICWA-100[0].Page2[0].List7[0].Li5[0].#area[0].check_cb[0] (0.36 conf)
icw_page_list_li_text_field__24 was ICWA-100[0].Page2[0].List7[0].Li5[0].TextField1[0] (0.34 conf)
page_title_party_name_child__2 was ICWA-100[0].Page3[0].pxCaption[0].TitlePartyName[0].ChildName[0] (0.33 conf)
icw_page_px_caption_case_number_ft__2 was ICWA-100[0].Page3[0].pxCaption[0].CaseNumber[0].CaseNumber_ft[0] (0.31 conf)
page_list_li_area_check_cb__2 was ICWA-100[0].Page3[0].List8[0].Li3[0].#area[0].check_cb[0] (0.36 conf)
icw_page_list_li_text_field__25 was ICWA-100[0].Page3[0].List8[0].Li3[0].TextField[0] (0.34 conf)
page_list_area_petitioner_cb was ICWA-100[0].Page3[0].List8[0].#area[0].petitioner_cb[0] (0.32 conf)
icw_page_list_li_cb__1 was ICWA-100[0].Page3[0].List8[0].Li1[0].has8a_cb[0] (0.36 conf)
icw_page_list_li_cb__2 was ICWA-100[0].Page3[0].List8[0].Li1[0].has8a_cb[1] (0.36 conf)
icw_page_list_li_b_cb__1 was ICWA-100[0].Page3[0].List8[0].Li2[0].has8b_cb[0] (0.36 conf)
icw_page_list_li_b_cb__2 was ICWA-100[0].Page3[0].List8[0].Li2[0].has8b_cb[1] (0.36 conf)
icw_page_list_li_text_field__26 was ICWA-100[0].Page3[0].List9[0].Li1[0].TextField[0] (0.34 conf)
icw_page_list_li_area_check_box__17 was ICWA-100[0].Page3[0].List10[0].Li1[0].#area[0].CheckBox1[0] (0.35 conf)
icw_page_list_li_text_field__27 was ICWA-100[0].Page3[0].List10[0].Li1[0].TextField[0] (0.34 conf)
icw_page_date_dt was ICWA-100[0].Page3[0].Date_dt[0] (0.37 conf)
icw_page_text_field was ICWA-100[0].Page3[0].TextField[0] (0.31 conf)

We've done our best to group similar variables togther to avoid overwhelming the user.

Suggested Screen 0:

icw_page_case_number_ft
icw_page_court_info_crt_county
icw_page_court_info_crt_street
page_court_info_crt_mailing_add
page_court_info_crt_city_zip
icw_page_court_info_crt_branch
page_header_title_party_name_child
page_title_party_name_date_time
page_title_party_name_department
icw_page_list_li_child_name
icw_page_list_li_fill_text__1
icw_page_list_li_fill_text__2
icw_page_list_li_text_field__1
icw_page_list_li_text_field__2
icw_page_list_li_text_field__3
icw_page_list_li_text_field__4
icw_page_list_li_text_field__5
icw_page_list_li_text_field__6
icw_page_list_li_text_field__7
icw_page_list_li_may_cb__1
icw_page_list_li_may_cb__2
icw_page_list_li_check_box_ab__1
icw_page_list_li_interven_cb__1
icw_page_list_li_interven_cb__2
icw_page_list_li_check_box_ab__2
icw_page_list_li_text_field__8
icw_page_list_li_date_field
icw_page_list_li_text_field__9
icw_page_list_li_area_check_box__1
icw_page_list_li_area_cb__1
icw_page_list_li_area_cb__2
page_list_li_area_fur_comm
icw_page_list_li_text_field__10
page_title_party_name_child__1
icw_page_px_caption_case_number_ft__1
icw_page_list_li_area_check_box__2
icw_page_list_li_text_field__11
icw_page_list_li_area_check_box__3
icw_page_list_li_text_field__12
icw_page_list_li_area_check_box__4
icw_page_list_li_text_field__13
icw_page_list_li_area_check_box__5
icw_page_list_li_text_field__14
icw_page_list_li_area_check_box__6
icw_page_list_li_text_field__15
icw_page_list_li_area_check_box__7
icw_page_list_li_text_field__16
icw_page_list_li_area_check_box__8
icw_page_list_li_text_field__17
icw_page_list_li_area_check_box__9
icw_page_list_li_text_field__18
icw_page_list_li_area_check_box__10
icw_page_list_li_text_field__19
icw_page_list_li_area_check_box__11
icw_page_list_li_text_field__20
icw_page_list_li_area_check_box__12
icw_page_list_li_text_field__21
icw_page_list_li_area_check_box__13
icw_page_list_li_area_cb__3
icw_page_list_li_area_cb__4
icw_page_list_area_checkbox
icw_page_list_li_area_check_box__14
icw_page_list_li_area_cb__5
icw_page_list_li_area_cb__6
icw_page_list_li_area_check_box__15
icw_page_list_li_area_b_cb__1
icw_page_list_li_area_b_cb__2
icw_page_list_li_area_check_box__16
icw_page_list_li_area_c_cb__1
icw_page_list_li_area_c_cb__2
icw_page_list_li_check_box
icw_page_list_li_text_field__22
icw_page_list_li_text_field__23
page_list_li_area_check_cb__1
icw_page_list_li_text_field__24
page_title_party_name_child__2
icw_page_px_caption_case_number_ft__2
page_list_li_area_check_cb__2
icw_page_list_li_text_field__25
page_list_area_petitioner_cb
icw_page_list_li_cb__1
icw_page_list_li_cb__2
icw_page_list_li_b_cb__1
icw_page_list_li_b_cb__2
icw_page_list_li_text_field__26
icw_page_list_li_area_check_box__17
icw_page_list_li_text_field__27
icw_page_date_dt
icw_page_text_field

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The Legal Innovation & Technology Lab's Form Explorer Beta @ Suffolk Law School Last updated 2023-04-02

Tribal Information Form

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The Legal Innovation & Technology Lab's Form Explorer ^Beta @ Suffolk Law School Last updated 2023-04-02