DFPS Discharge Notice Form 2109: Staffing, Submission, and Records

The DFPS discharge notice form, officially Form 2109 (Residential Child Care Discharge Notice), is the document a Texas residential child care contractor files to tell the state it is requesting that a child leave the facility. The completed notice goes to three recipients: the child’s assigned DFPS caseworker, that caseworker’s CPS supervisor, and the regional placement unit for the child’s legal region.¹ Download the current version (revised February 2026) as a Word document from the DFPS Residential Child Care Contracts and Forms page.²

Hold a Placement Support Staffing First

Before anything else, confirm a Placement Support Staffing has already been held. If it has not, stop. The form itself directs you to email dfpsdisruptionprevention@dfps.texas.gov with the child’s name, Person ID (PID), your organization’s name, and your contact information. A DFPS representative will call to schedule a meeting aimed at preserving the placement.¹ Skipping this step is the fastest way to have a discharge notice flagged as incomplete. The staffing exists so DFPS can look at whether added services could prevent the disruption before the child moves again.

Completing Form 2109 Section by Section

The form has five sections. Only the recommendation at the end calls for narrative. Every checkbox and identifier matters because the caseworker and supervisor review the notice for accuracy before acting on it.³

Child’s Information

Enter the child’s full legal name, date of birth, and Person ID (PID) number. The PID is assigned within DFPS’s IMPACT case-management system.⁴ If you do not have the PID, contact the assigned caseworker. The number has to be correct, because it links the notice to the child’s full case history.

Type of Discharge Notice

Select exactly one of the four notice types. Each one signals how much advance warning you are giving DFPS:

24-Hour Emergency Discharge Notice. Used when circumstances demand immediate removal. The emergency designation triggers the Placement Support Staffing requirement above.
10-Day Discharge Notice. Available only to General Residential Operations (GROs) that provide emergency care services.
14-Day Discharge Notice (Non-Emergency). The standard non-emergency timeline for most contracted providers.
30-Day Discharge Notice (Non-Emergency). A longer notice period, often used for planned transitions.

The caseworker and supervisor confirm that the type of notice matches both the type of agency and the stated reasons.³ A 24-hour emergency notice chosen for a non-emergency, or a 30-day notice when the child is already gone, will come back for correction.

Contractor Information

This section identifies your organization and the person responsible for the notice:

Contractor Name — the legal name of the contracting entity.
Resource ID Number — your DFPS-assigned resource identifier.
Date Form Completed.
Person Completing the Form — full name of the responsible staff member.
Contact Phone Number — a direct line for follow-up questions.
Contracted Service Type — select one option, including GRO Child Care Services, GRO Providing Treatment Services, GRO Emergency Services, Child Placing Agency (CPA), Child-Specific Contract (CSC), Supervised Independent Living (SIL), Intensive Psychiatric Transition Program (IPTP), Qualified Residential Treatment Program (QRTP), Treatment Foster Family Care (TFFC), and Intensive Psychiatric Stabilization Program (IPSP).¹

Discharge Reason

Check every reason that applies. This is a select-all field, not a single-choice question. The form lists sixteen options:¹

Achieved therapeutic goals
Child’s behavior
Caregiver moved
Change of verification and license type
Not least restrictive
Not verified and licensed to serve
Facility or home closed or inactive
Risk or actual abuse or neglect
Service Package change (T3C System)
Remains in placement, change of child placing agency (CPA)
Service level decreased
Service level increased
Child incarcerated
Child hospitalized
Child detained in a locked facility, jail, or juvenile detention facility
GRO discharging due to 24-Hour Awake Supervision Requirement (GROs only)

Be precise. If a child was hospitalized and behavior was the underlying issue, check both “Child hospitalized” and “Child’s behavior.” Understating the reasons creates problems downstream when the next placement tries to plan services.

Efforts to Prevent Placement Disruption

DFPS wants a record of what you tried before requesting the discharge. Check all that apply:

Utilized the YES waiver or contracted LMHA YES Waiver contact
Utilized Targeted Case Management (TCM) Rehab services
Contacted STAR Health Turning Point (available in Bexar, Harris, and Tarrant counties and the Brownwood and Abilene areas only)
Contacted the local mental health authority (LMHA) mobile crisis team
Utilized STAR Health Service Coordination
Utilized STAR Health Complex Case Management
Turning Point (if available in your region)
Other, with a space to describe what you did

Leaving this section blank signals that no effort was made to stabilize the placement. Even for a 24-hour emergency discharge, document whatever was attempted before the crisis escalated.¹

Recommendation

The final section is an open text field asking for your recommendations for the child’s future placement. The form suggests describing the child’s triggers, the type of placement the child needs, and any special supervision or services that would help. This is the part the next provider reads most carefully. Be specific. “Needs a structured environment” tells the caseworker nothing useful. “Does well with one-on-one redirection, escalates in group settings larger than four, and benefits from a consistent male caregiver” gives them something to work with.

Submitting the Form

The completed form goes to the child’s assigned DFPS caseworker, the caseworker’s CPS supervisor, and the regional placement unit for the child’s legal region.¹ The form’s instructions do not name a single portal or electronic system for transmission. Contact your regional placement unit or the caseworker directly to confirm the preferred delivery method for your region, and keep a dated copy showing when and to whom the notice was transmitted.

The caseworker and supervisor review the notice to verify that it is appropriate and that the discharge type matches both the agency type and the stated reasons.³ If something looks inconsistent, such as a non-emergency notice type paired with an emergency reason, expect the notice to come back for correction before DFPS acts on it.

Records You Must Send to the Next Placement

Form 2109 is the notice. The transition packet is separate. Texas Administrative Code §748.1439 requires you to provide a packet of records to the next placement or caregiver. First, attempt to obtain legal consent to release the information, and document that attempt in the child’s record whether or not consent is granted. If consent is obtained, the records must reach the receiving placement within 15 days of the discharge date.⁵

The required documentation includes:

A written discharge summary covering services provided during the stay, accomplishments, an assessment of remaining needs, recommendations for services to address those needs, support resources with phone numbers and addresses, and aftercare plans covering medical, psychiatric, psychological, dental, educational, and social appointments.
Background information, including progress notes from the past 60 days if applicable.
Any unresolved incidents or investigations involving the child.
Assessments and evaluations you performed, including admission, diagnostic, educational, and neurological assessments and any psychiatric or psychological evaluations.⁵

The §748.1439 list does not specifically require school transcripts, IEP documents, or immunization records in the discharge packet. You are, however, required to maintain current immunization records for each child in your care under §748.1539.⁶ As a practical matter, including immunization records and educational documents, especially IEPs, helps the next caregiver enroll the child in school without delay.

Internal Documentation and Record Retention

Beyond what you send out, you must document the date and circumstances of the discharge or transfer in the child’s record at your facility.⁷ That internal entry is separate from Form 2109 and from the §748.1439 packet. It is what stays in your own files and will be reviewed during licensing inspections or any future investigation involving the child.

You must keep the child’s complete record, from admission through discharge, for at least two years from the discharge date, or until the resolution of any investigation involving the child, whichever is longer.⁸ If an investigation is open at discharge, the clock does not start until that investigation closes.

When Form 2109 Doesn’t Apply

Form 2109 is for contractor-requested discharges. The process is different when DFPS decides to move the child. Under the 24-Hour Residential Child Care Contract requirements, DFPS provides the contractor 30 calendar days’ notice before removing a child when possible, and emergency care services providers receive at least five calendar days’ notice. DFPS is not required to give advance notice when the removal is court-ordered, when there is an immediate threat to the child’s health or safety, or when the provider itself requested the removal. If DFPS discharges a child with less than 30 days’ notice, the provider can request a signed document from the DFPS program director or higher-level manager explaining the reasons and the shortened timeline.⁹

If the child is being discharged to a placement in another state, the Interstate Compact on the Placement of Children (ICPC) adds paperwork on top of Form 2109. The key document is ICPC-100B, which reports changes in placement status and closes an ICPC case. It routes through ICPC administrators in both the sending and receiving states, so build in extra processing time compared to an in-state discharge.¹⁰

1
Texas Department of Family and Protective Services. Residential Child Care Discharge Notice Form
2
Texas Department of Family and Protective Services. Residential Child Care Contracts and Forms
3
Texas Department of Family and Protective Services. 4000 Placing Children in DFPS Conservatorship
4
Texas Department of Family and Protective Services. 1170 Program Planning; 1180 Information Systems
5
Cornell Law Institute. 26 Tex. Admin. Code 748.1439 – When I Discharge a Child, What Information Must I Provide to the Next Placement or Caregiver?
6
Texas Health and Human Services. Minimum Standards for General Residential Operations
7
Texas Rules by Elaws. Texas Administrative Code Title 26 Chapter 748 Section 748.1437
8
Cornell Law Institute. 26 Tex. Admin. Code 748.433 – How Long Must I Maintain Child Records?
9
Texas Department of Family and Protective Services. 24-Hour Residential Child Care Requirements
10
North Carolina Department of Health and Human Services. Instructions for Completing ICPC Form 100B Interstate Compact Report on Child’s Placement Status