If you still want to adopt the child, one signs in the affirmative and another process begins. If one wants to stop an adoption one is free to do so at this point without getting a black mark from China. The latter happens for any number of reasons - change in family circumstances - health, loss of a job, death and other things.
Since we wished to proceed with the adoption, we signed in the affirmative basically telling China, come hell or high water we're coming for him. The next step was to fill another form with the United States Immigration agency (USCIS) so they, who had approved us to adopt a child from China, would agree for us to adopt this specific child.
That form was sent off a few days after LOA arrived at our house. The IRS was kind enough to ask about the same time for detailed information - ie did you really spend over $13,170 to adopt each child? Well that was fun. Not. That was sent off just before Christmas.
Meanwhile, once LOA arrived, we were free to send a package to him, which we did in the form of a birthday cake for his 12th birthday (December 16) and letter to him. I wrote the orphanage director, that we, who had adopted Tian three years prior, would now be Jie Jun's parents. A few days later, photos of the letter we sent him, pictures and then pictures of him with friends enjoying his cake were sent to us.
Introduction Letter of Us to Jie Jun
Happy 12th Birthday, Jie Jun
While we were gone for the holidays, to the brown Minnesota Christmas, the US Government agreed with China that we could adopt this specific child and marked us approved 29 Dec 2011 and created a document stating such.