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    • DSS-5268-ia

      • Adam Walsh Clearances To obtain child abuse and neglect clearances to approve an individual to become a foster parent or to adopt, please complete the DSS-5268-ia. Agencies entitled to this information include licensed child care providers, group home facilities, Guardian ad Litem staff and child placing agencies.
      www.ncdhhs.gov › divisions › social-services
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  2. CPS BACKGROUND/ADAM WALSH BACKGROUND CLEARANCE REQUEST *****PLEASE COMPLETE THIS FORM ON LINE AND THEN PRINT ***** Part I: PURPOSE OF SEARCH A. RELEASE TO SELF: 1. To determine if I have been found responsible for an “indicated” or “unsubstantiated” disposition for a child abuse or neglect investigation. 2.

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  3. State Requirements. Guam, Kentucky, Louisiana, Maine, Michigan, Ohio, Oregon, Rhode Island do not require a form. Oklahoma has no central registry. Puerto Rico has no clear child abuse registry available.

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    State Requires Their Form
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  4. Adam Walsh State Contacts and Procedures for Child Abuse Registry Checks. Phone: (916) 210-4092 Fax: (916) 227-6364. BGC.Verification@ct.gov. submitted via the CT-KIND portal. Applicants are still required to submit signed authorization to the requesting agencies and the agencies should retain the signed forms for their records.

  5. Call 919-527-6370 for questions regarding this process. To request information from the North Carolina Division of Social Services please refer to the following Adam Walsh Clearances To obtain child abuse and neglect.

  6. To begin the online request application process, please download the Public Individual Child Abuse and Neglect (Google Chrome browser is preferred). You may submit the following payments online: credit card and e-check with your request. Online requests will be processed within 10 days.

  7. Out-of-State CPS Request. Please review the instructions for the detailed explanation process and additional requirements based on your agency type. A Child Protective Service (CPS) Screening Request may be submitted by the following: State & Government agencies; Child Placement Agencies (CPA)

  8. Return the completed form to the Local Department of Social Services in the Maryland jurisdiction where you currently reside. FORMS SENT TO THE INCORRECT ADDRESS WILL. CAUSE A DELAY IN THE REQUEST BEING PROCESSED. The request should be addressed to the CPS Background Clearance Coordinator.

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