Identix Identification Service Form – Fill Out and Use This PDF

To schedule an appointment, visit www.identix.com/iis or call 1-888-467-2080

Authorized Agency Information (To be completed by Requesting Agency)

Agency ORI __ TX922080Z			Agency Name Texas Department of Family and Protective Services – RCCL
Reason for fingerprinting: Prospective Foster/Adoptive Applicant or Adults in The Home.				.

Agency Assigned Applicant Number _____________________________________________________________________________________

(if required by Agency)

Original TCN __________________________________________________________________________________________________________

(if resubmission for rejected prints)

Applicant Information (To be completed by Applicant)

Applicant Last Name						First Name _______________	Middle Name ___________________
				(please print)
Sex	Male	Female		Race _________ Ethnicity __________________ Skin Tone _______________________________
				(W, B, A, I, O)		(Hispanic or Non-Hispanic)
Date of Birth _____________________ Height ___________					Weight ___________ Hair Color __________ Eye Color ____________
				(feet and inches)
Place of Birth __________________ Citizenship _________________ Social Security No.							___________________________________
		(state or country)		(country)

DL / ID No. _______________________________________ State Issuing DL / ID No. __________________________________________

Home Address __________________________________________________________________________________________________________

Street Address

City

State

Zip

Service Center Information (To be completed by Live Scan Operator)

Date Prints Taken _______________________ Amount Charged For Service _______________________________________________

Paid by:	Check	Money Order	Visa	MasterCard	Billing Acct ______________________________________
		At time of scheduling		At time of appointment

TCN _____________________________________________________________________________________________________________________

I HAVE COMPARED THE GOVERNMENT-ISSUED IDENTIFICATION PRESENTED BY THE APPLICANT AND ATTEST THAT TO MY BEST DETERMINATION, I HAVE FINGERPRINTED THE SAME PERSON.

Name of LSO ____________________________________________________________________________________________________________

(please print)

Signature of LSO ________________________________________________________________________________________________________

INSTRUCTIONS FOR USING THE IDENTIX FAST PASS FINGERPRINT SYSTEM

The goal of the FAST PASS fingerprints is to provide the applicant a fast, simple, convenient, and professional fingerprinting experience. The sooner the background check process is completed, the sooner your home can be verified.

Here’s how to get started:

1.Complete the middle portion of the form. Then schedule an appointment by either going online to the Identix website at www.identix.com/iis, click on the "Schedule a Fingerprinting Appointment On-line" button on the left or by calling Identix at toll-free at 1-888-467-2080 (8am-5pm CST).

2.Have this form with you, it has information such as our agency's ORI number and the reason you're being fingerprinted.

3.When scheduling online, you must select the following:

•First select, Texas,

•Then the language that you would like to register in (either English or Spanish),

•Then choose All Others for the type of agency under the application ID;

•Then select Option A – Electronic Submission for the type of fingerprints needed.

•Then select yes, I have a Fast Fingerprint Pass

•Then enter the following Agency ORI number, TX922080Z (This is a very important step!!! If you do not enter the correct ORI number, DFPS will not receive the results of the fingerprint check and you will have to conduct another check and pay an additional $48.95 fee).

•Then select yes for the state and federal background check

•Then enter your zip code and the region of the state that you would like to have your prints taken, click next step.

•Then click on the available date on the calendar and the preferred time.

•On the next page enter in all of your required information and click send information. After you have registered on-line you will receive a confirmation email of your scheduled appointment.

4.If you choose to schedule via phone, request an “Electronic Fingerprint Submission” and the operator will obtain the above information from you.

5.Arrive at the facility at your appointed time.

6.Bring the following with you to your fingerprinting appointment:

•This completed FAST PASS Form;

•Your driver's license or other valid form of identification; and

•The form of payment you selected when you made your appointment. $48.95 ($39.00 for the DPS/NCIC fingerprints and the $9.95 for the processing fee). Identix will accept personal checks, money orders or credit cards.

7.The technician will run your fingerprints, take your photograph and give you a signed receipt.

8.Your fingerprints will then be sent electronically to DPS, DPS will send the print to NCIC (FBI) electronically the same day.

9.You must submit the signed receipt to your child placing agency or independent foster home provider as proof of fingerprinting.

10.The results will be sent directly to Licensing from the Texas Department of Public Safety. Licensing will notify your child placing agency of the results.