Downloading a Form to Your Computer

Fillable forms cannot be viewed on mobile or tablet devices. Follow the steps below to download and view the form on a desktop PC or Mac.

  1. Right Click for PC or Ctrl + Click for Mac on the PDF link and click “Save link as” from the menu.
  2. Select the folder you want to save the file in and then click "Save."
  3. Navigate to the folder you saved the file in and Right Click for PC or Ctrl + Click for Mac, then select "Open With" from the menu and select Adobe Acrobat Reader DC.

    Note: Open the PDF file from your desktop or Adobe Acrobat Reader DC. Do not click on the downloaded file at the bottom of the browser since it will not open the PDF in Adobe Acrobat Reader DC. It will try to open the file in the browser that results in the same browser error message.

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Effective Date: 




Updated: 4/2017



Form 4201 is used to:

  • identify and document the reason a surrogate parent is needed, and
  • assign a surrogate parent.

Detailed Instructions

File the original form in the child’s record. If a surrogate parent is assigned, provide a copy to the surrogate parent.


Note about Retention

Unless a longer period is required by state or federal law, the contractor must retain records for five years after the child has been dismissed from services.