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PCA 331

Statement of Child-Placing Agency Transferring Physical Custody of Child for Adoption

Michigan · Michigan State Court Administrative Office · Effective September 1, 2023

This form is a statement from a child-placing agency that tells the court that physical custody of a child has been temporarily given to prospective adoptive parents for the purpose of adoption. It includes details about the parents and the agency's confirmation that the placement is authorized.

The court describes it as: Court rule / statute: MCL 710.23d

Open the official PDFfrom Michigan State Court Administrative Office

Where this fits in a case

Start a case

Stage: Start a case

This form is used when a child-placing agency needs to officially tell the court that they have temporarily placed a child with prospective adoptive parents for an adoption.

Prepared by the court or clerk.

Common questions

Who fills out this form?
A representative of the child-placing agency fills out this statement on behalf of the agency.
What does this form show?
It shows that physical custody of the child was temporarily moved to the prospective adoptive parents for adoption purposes.
Are documents attached?
The form mentions that the agency attaches a copy of the authorization and a statement from the prospective adoptive parents.

Revision history

No changes recorded since we started tracking this form on October 9, 2026. The current version took effect September 1, 2023.

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