State Of Alabama Central Registry Clearance Details

Alabama Central Registry Clearance is required for individuals who want to become foster parents in the state of Alabama. The clearance verifies that the individual does not have a history of child abuse or neglect. This article will provide more information on the clearance process and how to obtain it. If you are interested in becoming a foster parent in Alabama, you must first obtain clearance from the Alabama Central Registry (ACR). The ACR is a statewide registry that maintains information on individuals who have been accused or convicted of child abuse or neglect. The clearance verification confirms that you do not have a history of child abuse or neglect and allows you to proceed with the application process to become a foster parent.

The table provides information regarding the alabama central registry clearance. It could be useful to learn its size, the average time required to fill out the form, the blanks you'll have to fill in, and so forth.

QuestionAnswer
Form NameAlabama Central Registry Clearance
Form Length1 pages
Fillable?Yes
Fillable fields37
Avg. time to fill out7 min 43 sec
Other namesdissemination, dhr can report, how to get a can central registry clearance done in alabama, alabama central registry clearance form

Form Preview Example

ALABAMA DEPARTMENT OF HUMAN RESOURCES

CHILD ABUSE / NEGLECT (CA/N) CENTRAL REGISTRY CLEARANCE

PRINT OR TYPE in black or blue ink. Additional information regarding the CA/N Central Registry is on the back of this form.

** See instructions for the address to use when submitting this form. **

Requesting Person or Agency/Organization

 

 

Check All That Apply

 

 

 

 

 

 

Mailing Address

 

 

 

 

Child Placing Agency

 

 

 

 

 

 

 

 

 

 

 

Residential Child Care Facility

 

 

 

 

 

 

 

 

 

 

 

Child Day / Night Care Center

 

 

 

 

 

 

Telephone Number (

)

 

Email:

 

Family Day / Night Care Home

 

 

 

 

 

 

PRINT Requestor’s Name

 

 

 

 

Exempt Child Day Care Center

 

 

 

 

 

 

Requestor

 

 

 

Date

Medicaid Rehab. Provider

Signature

 

 

 

 

DHR Vendor

 

 

 

 

 

 

Witness

 

 

 

Date

Other (Please Specify)

Signature

 

 

 

 

_________________________________

 

 

 

 

 

The person whose name and identifying information, printed or typed below, will provide unsupervised care and

supervision of children as an

employee

volunteer

other. This person’s specific job/role is or will be:

_________________________________________________________________________________________________

_________________________________________________________________________________________________

Name _____________________________________________ Sex

Last First Middle

Male

Race ___________ DOB ___/___/______

Female

 

Current Mailing Address

__________________________________________________________________________

Alias, Maiden & Prior Married Name(s)

______________________________________________________________

Name & DOB of Spouse & Former Spouse(s)

_________________________________________________________

Name & DOB of Children / Stepchildren

______________________________________________________________

Alabama counties where person has lived and/or worked

_________________________________________________

Attach additional pages as needed to provide all information requested above.

To be completed by person being cleared

I authorize the Alabama Department of Human Resources to release information contained in the Child Abuse / Neglect Central Registry about me to the above named person/agency/organization. I hereby waive any right to any review or hearing to which I may otherwise be entitled. I further release the Department of Human Resources, its officers, and employees from any and all claims arising out of or in any way connected to the release or dissemination of any information concerning me.

_________________________________

________________

_________________________________

________________

Signature

Date

Signature of Witness

Date

To be completed by DHR

A search of the Alabama Child Abuse / Neglect Central Registry has been completed with the information provided to determine if the person identified above has been named as being responsible for child abuse or neglect in Alabama. DHR releases only that information which is necessary to discover or prevent child abuse / neglect.

Substantiated report (i.e., indicated) located. See attached information.

Type Report:

Physical Abuse

Neglect

Sexual Abuse

Mental Abuse / Neglect

No report located.

 

 

 

 

Request Denied

______________________________________________________________________________

Other _________________________________________________________________________________________

_________________________________________________________

______________________________________

Office of Child Protective Services

 

 

Date Completed

DHR-FCS-1598 (Revised December 2009)

How to Edit Alabama Central Registry Clearance

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step 1 to completing alabama child abuse registry

Indicate the details in Name, Middle, First, Last, Sex, Male Female, Race ___________ DOB ___/___/______, Current Mailing Address, Alias, Name & DOB of Spouse & Former, Name & DOB of Children /, Alabama counties where person has, Attach additional pages as needed, To be completed by person being, and I authorize the Alabama Department.

alabama child abuse registry Name, Middle, First, Last, Sex, Male Female, Race ___________ DOB ___/___/______, Current Mailing Address, Alias, Name & DOB of Spouse & Former, Name & DOB of Children /, Alabama counties where person has, Attach additional pages as needed, To be completed by person being, and I authorize the Alabama Department fields to complete

Mention the important details in I authorize the Alabama Department, _________________________________, ________________ Date, _________________________________, ________________ Date, A search of the Alabama Child, Substantiated report (i, Type Report:, Physical Abuse, Neglect, Sexual Abuse, Mental Abuse / Neglect, No report located, Request Denied, and Other box.

part 3 to entering details in alabama child abuse registry

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