Dcf 136 Form – Fill Out and Use This PDF

Dcf 136 Form PDF Details

What Is the DCF 136 Form?

The DCF 136 form is the official written report for suspected child abuse or neglect in Connecticut. Issued by the Connecticut Department of Children and Families (DCF), it is formally titled "Report of Suspected Child Abuse or Neglect." Mandated reporters submit this document to a DCF area office within 48 hours of completing an initial phone call to the DCF Careline at 1-800-842-2288. The form gives child protection investigators the documented facts they need to open a formal inquiry into potential maltreatment.

Who Must File a DCF 136 Form?

Connecticut law designates certain professionals as mandated reporters. These individuals are legally required to report any reasonable suspicion of child maltreatment to state authorities. Mandated reporters include:

• Teachers, school principals, guidance counselors, and other school staff
• Physicians, nurses, and other licensed healthcare providers
• Licensed clinical social workers and mental health professionals
• Police officers and law enforcement personnel
• Day-care workers, coaches, and youth program staff
• Clergy members in certain professional capacities

Once any of these professionals has reasonable cause to suspect abuse or neglect, they must first call the Careline to make a verbal report, and then file the DCF 136 form within 48 hours as written confirmation of that call.

Information Required on the DCF 136 Form

The form is divided into several sections, each capturing different details about the reported situation:

• Child section: full name, date of birth, age, gender, race, home address, and the name of the child's school or day-care facility
• Parent or guardian section: names, home addresses, and contact information for each parent or guardian
• Suspected perpetrator: name, address, and relationship to the child, if this information is known at the time of the report
• Description of abuse or neglect: a written account of the circumstances that raised concern, any injuries observed, and any prior incident history
• Reporter section: the full name, agency name, professional position, phone number, agency address, and signature of the person submitting the report

Where to Submit the Completed Form

After making the phone report to the Careline, mandated reporters must send the completed written form to the DCF area office that serves the district where the child lives. Connecticut DCF area offices are located in Bridgeport, Danbury, Hartford, Manchester, Norwalk, and several other cities across the state. Specific mailing addresses for each office are listed on the back page of the form itself. Submission must occur within 48 hours of the Careline call to satisfy the legal filing deadline.

Legal Protections for Reporters

Connecticut law provides immunity from civil and criminal liability to mandated reporters who make good-faith reports of suspected child abuse or neglect. Reporters who fail to file required reports may face legal penalties. The state's child protection statutes emphasize the collective responsibility that professionals hold in identifying and responding to potential harm, promoting family integrity, and securing a safe environment for children at risk.

Related Child Welfare and Reporting Forms

If you work with child welfare documentation across multiple states or agencies, you may also need related resources such as the PA Child Abuse History Clearance Form for Pennsylvania background screening, the Child Care Incident Report for documenting incidents at childcare facilities, or the Arkansas Child Abuse Reporting Form for mandated reporting in that state. For additional Connecticut legal forms, explore the Connecticut Custody Application.