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 (Mailing address is on the actual form in the top left text box).
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.
1. 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.
2. Check the *School Block if you are a prospective student teacher or prospective employee or contractor of a public or private school (School District, IU, Charter School, Career & Technology Center, Private Academic School, Non-Public School). See information below that applies to school employees.*
3. Check the Foster Care Block if applying for foster parenting or custody of a child.
4. Check the Adoption Block if in the process or planning to adopt a child.
5. Check the Child Care Block if planning to work in a day care setting or if all other blocks do not apply.
6. 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//index_dpw.htm, 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 $33.

*TheDepartment of Education also utilizes Cogent Systems to process finger print based FBI Criminal History Record Information reports for prospective employees of public and private schools. Under Act 114 of 2006, ALL prospective school employees, school contractors and student teachers are to use the Department of Education system. This includes but is not limited to: Teachers, School Administrators, Substitute Teachers, Teaching Assistants, PIAA Sports Officials, School Bus Drivers, and Student Teachers. Applicants may register online at: https://www.pa.cogentid.com/index_pde.htm.

For more information regarding Act 114, and background check requirements for public schools, private schools and student teachers go to the Department of Education Web site or contact the Department of Education at RA-PDE-SchoolService@pa.gov.

More information about this new requirement can be found by search for Bulletin #3490-08-03 in our Bulletin Search.

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