Al Form 1598 PDF Details

The DHR-FCS-1598 form, also called the Child Abuse/Neglect (CA/N) Central Registry Clearance Request, applies to employees and volunteers in child care facilities, Medicaid Rehabilitation service providers, and other roles covered under the Adam Walsh Act. Requestors must submit both the original form and one copy, with original signatures from both the requestor and the applicant, within 90 days of signing.

The applicant must list all former names and aliases, date of birth, Social Security Number, and residential addresses for the past five years. The State or County Department of Human Resources uses this information to search the Central Registry and determine if the individual has any prior child abuse or neglect findings.

For related Alabama background forms, see the Alabama Central Registry Clearance form, the DHR-FCS-1593 form, or our background check consent form templates.

QuestionAnswer
Form NameAl Form 1598
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesdhr can 1598, 1598 alabama form, alabama form 1598, alabama dhr form 1598

How to Edit Al Form 1598 Online for Free

Use FormsPal's free PDF editor to complete the Alabama DHR Form 1598 online without installing any software. Follow the steps below to fill out and submit the Child Abuse/Neglect Central Registry Clearance Request correctly.

Step 1: Open the form in your browser

Click the "Fill Online" or "Get Form" button at the top of this page. The DHR-FCS-1598 form opens directly in the FormsPal editor.

Step 2: Enter the requestor information

Complete the requestor section with the full name, address, and phone number of the requesting employer, agency, or organization. Indicate the position the applicant will hold and the purpose of the clearance check.

Step 3: Fill in the applicant's personal details

Provide the applicant's full legal name, all former names and aliases, date of birth, Social Security Number, and a five-year residential address history. This information is used to search the CA/N Central Registry.

Step 4: Select the request category

Check the applicable box for the request type: child care facility employee or volunteer, Medicaid Rehabilitation service provider, Adam Walsh Act request, or another applicable category. Each category has specific submission requirements.

Step 5: Sign and submit the form

Both the requestor and the applicant must provide original signatures. Submit the original form and one copy to your County or State Department of Human Resources within 90 days of signing. Keep a copy for your records.

Also see the PA Child Abuse History Clearance form, the Arkansas Child Abuse form, and the DHR-CHC-2178 form for related child background check forms.