Pennsylvania Child Abuse History Clearance Forms
Pennsylvania Child Abuse History Clearance Instructions
Note: See new requirements for Federal Bureau of Investigation
clearance at the bottom of the page.
Please read the instructions prior to downloading the form. To request
a supply of the forms, please call (717) 783-6211.
- Type or print clearly and neatly in ink Section I only.
- Address must be Applicant's current home address.
- All information must be completed in full. (The form asks for all
previous names, addresses, and household members since 1975). This
information must be provided to the best of your knowledge and belief.
If necessary, attach additional pages.
- Application must be signed.
- Enclose a $10.00 money order for each application. No cash or
personal checks accepted. Agency or business checks are acceptable.
- Do not send any postage paid return envelopes.
- Application should be placed in a business-sized or larger envelope
prior to mailing.
- One block must be checked for Purpose for Clearance. Do not check
more than one block.
- Check the Volunteer Block if performing a service (paid or unpaid)
for organizations such as Big Brothers/Big Sisters, Boy Scouts, Little
League or churches. A copy of your Criminal Record Check results
obtained within the past year must be attached. Do not send original
Criminal Record results. If you are not a Pennsylvania resident, you
must also attach a copy of your FBI results obtained within the past
year. This block should not be checked for anyone volunteering in
schools.
- Check the School Block if seeking to have involvement within a
school (public, private vocational, technical, nursing) for any
reason.
- Check the Foster Care Block if applying for foster parenting or
custody of a child.
- Check the Adoption Block if in the process or planning to adopt a
child.
- Check the Child Care Block if planning to work in a day care
setting or if all other blocks do not apply.
- Check the CWEP Block if you are participating in a Department of
Public Welfare training program. The signature and phone number of the
County Assistance Representative is required.
Clearance results will be mailed to you within 14 days from the date
that the clearance is received in our office. There will be no
replacements after 90 days. Failure to comply with the above instructions
will cause considerable delay.
Please contact the following for applicable criminal history requests:
PA Criminal Record Checks (SP4 164): (717) 783-9973
FBI Cards for School Employees (FD 258): (717) 783-3750
If you have trouble accessing this information you may obtain an
alternative format by contacting the Office of Children Youth and Families
at (717) 783-6211. You can also call (717)
783-6211 for clearance requests.
Pennsylvania Child Abuse History Clearance Form (CY-113)
Pennsylvania State Police Request for Criminal Record Check Form (SP4-164)
New FBI Clearance Required
All of the following individuals are now required to submit Federal
Bureau of Investigation criminal history background checks in addition to
child abuse and Pennsylvania State Police background checks as a condition
of employment/approval:
- Prospective foster and adoptive applicants and their adult household
members;
- Individuals who want to operate child care facilities;
- Individual who want to work in child care facilities;
- Individuals seeking to operate child care services;
- Individuals applying for employment with a significant likelihood of
regular contact with children;
- Self-employed family day care providers;
- Family day care home household members age 18 and over who live in
the home at least 30 days in a calendar year;
- Community Rehabilitation Residential (CRR) host home families; and
- Respite provider families.
Current employees and providers of child care facilities are not
required to obtain FBI clearances as a condition of continued employment
by the same legal entity or continued operation. Employees may transfer to
another child care service under the same organization without having to
obtain FBI clearances as a condition of transferring. This follows the
same procedures already in law under the Child Protective Services Law.
An employee hired on a provisional basis will have to submit proof of
application for an FBI criminal history clearance in addition to the
current provisional hiring requirements in the Child Protective Services
Law. The length of the provisional hire period is unchanged. Pennsylvania
residents may be hired on a provisional basis for a single period of no
more than 30 days. Out-of-state residents may be hired on a provisional
basis for a single period of no more than 90 days.
Prospective employees applying to engage in occupations with a
significant likelihood of regular contact with children, in the form of
care, guidance, supervision or training must obtain background checks as a
condition of employment. These individuals, including but not limited to
social service workers, psychiatrists, hospital personnel, counselors and
therapists, librarians and doctors. Any additional requirements
surrounding provisional hiring periods or licensing implications related
to the completion of background checks for these individuals should be
directed to the appropriate licensing entity.
The Department of Public Welfare is utilizing Cogent Systems to process
fingerprint-based FBI record checks. The fingerprint based background
check is a multiple step process. Effective July 1, 2008, the Cogent
Systems Web site
www.pa.cogentid.com/dpw, allows individuals to apply online, as well
as provide detailed information regarding the application process. The
cost of obtaining the FBI criminal record check is $35.
More information about this new requirement can be found by search for
Bulletin #3490-08-03 in our
Bulletin Search.
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