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The Pennsylvania Child Abuse History Clearance form serves as a critical tool for individuals working or volunteering with children, providing a formal verification of their child abuse history. This process is essential for foster parents, prospective adoptive parents, and various child care service employees. To complete the application, individuals must provide personal details, including full legal names, social security numbers, and residential information since 1975. Many applicants may qualify for a free certificate if they are volunteers with direct contact with children, but non-volunteer requests require a $13.00 fee. It's important to remember that incomplete applications or those sent without the necessary payment will be returned unprocessed. Moreover, the form includes an option for individuals seeking permission to share their certification status with third parties, highlighting the need for transparency. Instructions clearly outline various purposes for certification, ensuring applicants select the right category while emphasizing compliance with state regulations. All applicants should also be aware of the 14-day processing timeframe and simplify their application process by carefully following the guidelines laid out. For any questions, assistance is available via specific contact numbers associated with the Pennsylvania Department of Human Services.

Pa Child Abuse History Clearance Example

PENNSYLVANIA CHILD ABUSE HISTORY CERTIFICATION

Type or print clearly in ink. If obtaining this certification for non-volunteer purposes or if, as a volunteer having direct volunteer contact with children, you have obtained a certification free of charge within the previous 57 months, enclose an $13.00 money order or check payable to the PENNSYLVANIA DEPARTMENT OF HUMAN SERVICES or a payment authorization code provided by your organization. DO NOT send cash.

Certifications for the purpose of “volunteer having direct volunteer contact with children” may be obtained free of charge once every 57 months.

Send to CHILDLINE AND ABUSE REGISTRY, PA DEPARTMENT OF HUMAN SERVICES, P.O. BOX 8170 HARRISBURG, PA 17105-8170.

APPLICATIONS THAT ARE INCOMPLETE, ILLEGIBLE OR RECEIVED WITHOUT THE CORRECT FEE WILL BE RETURNED UNPROCESSED. IF YOU HAVE QUESTIONS CALL 717-783-6211, OR (TOLL FREE) 1-877-371-5422.

PURPOSE OF CERTIFICATION (Check one box only)

Foster parent

 

Volunteer having direct volunteer contact with children

Prospective adoptive parent

 

If purpose is volunteer having direct volunteer contact with chil-

Employee of child care services

 

dren, choose SUB PURPOSE:

 

 

 

School employee governed by the Public School Code

 

Big Brother/Big Sister and/or affiliate

 

 

 

School employee not governed by the Public School Code

 

Domestic violence shelter and/or affiliate

 

 

 

Self-employed provider of child-care services in a family child-care home

 

Rape crisis center and/or affiliate

 

 

 

An individual 14 years of age or older applying for or holding a paid

 

Other:

 

 

 

 

 

position as an employee with a program, activity, or service

 

PA Department of Human Services Employment & Training Program

An individual seeking to provide child-care services under contract with a

 

 

participant (signature required below)

 

 

 

child care facility or program

 

 

 

 

 

 

 

 

 

 

 

An individual 18 years or older who resides in the home of a foster parent

 

 

 

 

 

 

 

for children for at least 30 days in a calendar year

 

 

 

 

 

 

SIGNATURE OF OIM/CAO REPRESENTATIVE

 

OIM/CAO PHONE

An individual 18 years or older who resides in the home of a certified or

 

 

 

 

 

NUMBER

licensed child-care provider for at least 30 days in a calendar year

 

 

 

 

 

 

 

 

 

 

 

 

 

 

An individual 18 years or older, excluding individuals receiving services, who resides in a family living home, community home for individuals with an intellectual disability, or host home for children for at least 30 days in a calendar year

An individual 18 years or older who resides in the home of a prospective adoptive parent for at least 30 days in a calendar year

AGENCY/ORGANIZATION NAME:

PAYMENT AUTHORIZATION CODE, IF APPLICABLE:

 

 

Consent/Release of Information Authorization form is attached. Applicant must fill in the “Other Address” sections. By completing the other address sections, you are agreeing that the organization will have access to the status and outcome of your certification application.

APPLICANT DEMOGRAPHIC INFORMATION (DO NOT USE INITIALS)

FIRST NAME

 

MIDDLE NAME

 

LAST NAME

SUFFIX

 

 

 

 

 

SOCIAL SECURITY NUMBER

GENDER

 

DATE OF BIRTH (MM/DD/YYYY)

AGE

___

___

Male

Female

 

 

Not reported

 

 

 

 

 

 

 

 

Disclosure of your Social Security number is voluntary. It is sought under 23 Pa.C.S. §§ 6336(a)(1) (relating to information in statewide database), 6344 (relat- ing to employees having contact with children; adoptive and foster parents), 6344.1 (relating to information relating to certified or licensed child-care home residents), and 6344.2 (relating to volunteers having contact with children). The department will use your Social Security number to search the statewide database to determine whether you are listed as the perpetrator in an indicated or founded report of child abuse.

HOME ADDRESS

MAILING ADDRESS

OTHER ADDRESS (if Consent/Release of

(if different from home address)

Information Authorization form is attached)

ADDRESS LINE 1

ADDRESS LINE 1

ADDRESS LINE 1

 

 

 

ADDRESS LINE 2

ADDRESS LINE 2

ADDRESS LINE 2

 

 

 

CITY

CITY

CITY

 

 

 

COUNTY

COUNTY

COUNTY

 

 

 

STATE/REGION/PROVINCE

STATE/REGION/PROVINCE

STATE/REGION/PROVINCE

 

 

 

ZIP/POSTAL CODE

ZIP/POSTAL CODE

ZIP/POSTAL CODE

 

 

 

COUNTRY

COUNTRY

COUNTRY

 

 

 

Different mailing address

ATTENTION

ATTENTION

 

 

 

 

 

 

 

 

 

CONTACT INFORMATION

 

HOME TELEPHONE NUMBER

WORK TELEPHONE NUMBER

MOBILE TELEPHONE NUMBER

EMAIL (By submitting an email contact, you are agreeing to ChildLine contacting you at this address.)

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PENNSYLVANIA CHILD ABUSE HISTORY CERTIFICATION

PREVIOUS NAMES USED SINCE 1975 (Include maiden name, nickname and aliases.)

First

Middle

Last

Suffix

1.

2.

3.

4.

5.

PREVIOUS ADDRESSES SINCE 1975 (Please list all addresses since 1975, partial address acceptable; attach additional pages if necessary.)

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

 

HOUSEHOLD MEMBERS

 

 

 

 

(Please list everyone who lived with you at any time since 1975 to present.

 

 

Please include parent, guardian or the person(s) who raised you; attach additional pages as necessary.)

 

 

Name (First, Middle, Last)

 

 

Relationship

Present

Gender

 

 

 

 

 

Age

 

1.

 

Parent

Guardian

person(s) who raised you

 

 

 

 

 

 

 

 

 

2.

 

Parent

Guardian

person(s) who raised you

 

 

 

 

 

 

 

 

 

3.

 

 

 

 

 

 

 

 

 

 

 

 

 

4.

 

 

 

 

 

 

 

 

 

 

 

 

 

5.

 

 

 

 

 

 

 

 

 

 

 

 

 

6.

 

 

 

 

 

 

 

 

 

 

 

 

 

7.

 

 

 

 

 

 

 

 

 

 

 

 

 

8.

 

 

 

 

 

 

 

 

 

 

 

 

 

9.

 

 

 

 

 

 

 

 

 

 

 

 

 

10.

 

 

 

 

 

 

 

 

 

 

 

 

 

I affirm that the above information is accurate and complete to the best of my knowledge and belief and submitted as true and correct under penalty of law (Section 4904 of the Pennsylvania Crimes Code). If I selected volunteer, I understand that I can only use the certificate for volunteer purposes.

APPLICANT’S SIGNATURE

DATE

CHILDLINE USE ONLY

DATE RECEIVED BY CHILDLINE

SUFFICIENT PAYMENT INFORMATION RECEIVED YES NO

VALID PAYMENT AUTHORIZATION CODE WAIVED (supervisor initials) ___________

CERTIFICATION ID #

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INSTRUCTIONS TO COMPLETE THE

PENNSYLVANIA CHILD ABUSE HISTORY CERTIFICATION APPLICATION:

General:

•Type or print clearly and neatly in ink only.

•If obtaining this certification for non-volunteer purposes or if, as a volunteer having direct volunteer contact with children, you have obtained a certification free of charge within the previous 57 months, enclose an $13.00 money order or check for each application. No cash will be accepted. Personal, agency, or business checks are acceptable. Certifications for the purpose of “volunteer having direct volunteer contact with children” may be obtained free of charge once every 57 months. If no payment is enclosed for a non-volunteer purpose, you must provide a payment authorization code, otherwise your application will be rejected and returned to you.

•DO NOT SEND POSTAGE PAID RETURN ENVELOPES for us to return your results. Results are issued through an automated system generated mailing process.

•Certification results will be mailed to you within 14 days from the date the certification application is received at the ChildLine and Abuse

Registry.

•Failure to comply with the instructions will cause considerable delay in processing the results of an applicant’s child abuse history certification application.

Purpose of Certification - Do not check more than one box:

•Check the foster parent box if applying for purposes of providing foster care.

•Check the prospective adoptive parent box if applying for the purpose of adoption.

•Check the employee of child care services box if applying for the purpose of child care services in the following:

-Child day care centers; group day care homes; family day care homes; boarding homes for children; juvenile detention center services or programs for delinquent or dependent children; mental health services for children; services for children with intellectual disabilities; early intervention services for children; drug and alcohol services for children; and day care services or other programs that are offered by a school.

•Check the school employee governed by the Public School Code box if you are a school employee who is required to obtain background checks pursuant to Section 111 of the Public School Code and will continue to be required to obtain background checks prior to employment in accordance with that section and on the periodic basis required by Act 153.

•Check the school employee not governed by the Public School Code box if you are a school employee not governed by Section 111 of the Public School Code, but covered by Act 153 (pertaining to school employees in institutions of higher education).

Definition of school employee: A school employee is defined as an individual who is employed by a school or who provides a program, activity or service sponsored by a school. The term does not apply to administrative or other support personnel unless they have direct contact with children.

Definition of school: A facility providing elementary, secondary or postsecondary educational services. The term includes the following:

(1)Any school of a school district.

(2)An area vocational-technical school.

(3)A joint school.

(4)An intermediate unit.

(5)A charter school or regional charter school.

(6)A cyber charter school.

(7)A private school licensed under the act of January 28, 1988 (P.L.24, No. 11), known as the Private Academic Schools Act.

(8)A private school accredited by an accrediting association approved by the state Board of Education.

(9)A non-public school.

(10)An institution of higher education.

(11)A private school licensed under the act of December 15, 1986 (P.L. 1585, No. 174), known as the Private Licensed Schools Act.

(12)The Hiram G. Andrews Center.

(13)A private residential rehabilitative institution as defined in section 914.1-A(c) of the Public School Code of 1949.

•Check the self-employed provider of child-care services in a family child-care home if providing child care services in one’s home

(other than the child’s own home) at any one time to four, five, or six children who are not relatives of the caregiver.

•Check the individual 14 years of age or older who is applying for or holding a paid position as an employee box if the employment is with a program, activity, or service, as a person responsible for the child’s welfare or having direct contact with children: Applying as an employee who is responsible for the child’s welfare or having direct contact (providing care, supervision, guidance, or control to children or having routine interaction with children) in any of the following in which children participate and which is sponsored by a school or public or private organization:

-A youth camp or program;

-A recreational camp or program;

-A sports or athletic program;

-A community or social outreach program;

-An enrichment or educational program; and

-A troop, club, or similar organization

•Check the individual seeking to provide child care services under contract with a child care facility or program box if you are providing child care services as part of a contract or grant funded program.

•Check the box for individual 18 years or older who resides in the home of a foster parent for at least 30 days in a calendar year if you are an adult household member in this setting and require certification.

•Check the box for individual 18 years or older who resides in the home of a certified or licensed child-care provider for at least 30 days in a calendar year if you are an adult household member in this setting and require certification.

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•Check the box for individual 18 years or older, excluding individuals receiving services, who resides in a family living home, community home for individuals with an intellectual disability, or host home for children for at least 30 days in a calendar year if you are an adult household member in this setting and require certification.

•Check the box for individual 18 years or older who resides in the home of a prospective adoptive parent for at least 30 days in a calendar year if you are an adult household member in this setting and require certification.

•Check the volunteer having direct volunteer contact with children box if applying for the purpose of volunteering as an adult for an unpaid position as a volunteer with a child-care service, a school, or a program, activity or service as a person responsible for the child’s welfare or having direct volunteer contact with children. In addition, check the box of one of the organizations listed, i.e. Big Brother/Big Sister, domestic violence shelter, rape crisis center. If you are NOT applying for a volunteer in one of the organizations listed, please check the other box and write the name of the organization in the space provided.

•Check the PA Department of Human Services employment & training program participant box if you are applying for the purpose of participating in a PA Department of Human Services employment and training program through a county assistance office (CAO) or the Office of Income Maintenance (OIM). The signature AND phone number of the CAO or OIM representative is required. If there is no signature and no phone number, your application will be rejected and returned to you.

•If you were provided a “PAYMENT AUTHORIZATION CODE” by an organization, please provide the agency/organization name in the space provided and the payment authorization code in the space provided.

•Please check the CONSENT/RELEASE OF INFORMATION box if you included a payment code in the space above and attached the completed Consent/Release of Information Authorization form to your Pennsylvania Child Abuse History Certification application when you mail it to our office. The Consent/Release of Information Authorization form allows the department to send your results to a third party.

If the Consent/Release of Information Authorization form is NOT attached to the certification application, the results WILL be mailed to the applicant’s home address and not to the third party.

Applicant Demographic Information:

•Name - Include the applicant’s full legal name. Initials are not acceptable for a first name. If your full legal name is an initial, please provide supporting documentation along with your certification application.

•Social Security number - Include the applicant’s social security number. A social security number is voluntary; HOWEVER, PLEASE

NOTE THAT APPLICATIONS THAT DO NOT INCLUDE SOCIAL SECURITY NUMBERS MAY TAKE LONGER TO BE PROCESSED.

•Gender - Please check one box.

•Date of birth - Fill in the applicant’s date of birth (Example: 01/22/1990).

•Age - Fill in the applicant’s current age.

Address:

•The address listed must be the applicant’s current home address. This is also where the results of the certification will be mailed, unless otherwise noted. If the different mailing address box is checked and a mailing address is provided in the “different” mailing address column, the results will be mailed to the “mailing” address and not the “home” address. Note: If the consent/release of information box is checked and an “other” address is provided, the results will be mailed to the “other” address.

Contact Information:

•Please provide your home, work or mobile telephone number. Fill in the number where the applicant can be reached in the event that there are questions about the information on the application.

•Please provide an email address. By providing an email address, you are consenting to ChildLine contacting you by email in the event that you cannot be reached by phone. NO CONFIDENTIAL INFORMATION WILL EVER BE SHARED OR PROVIDED IN AN EMAIL

FROM OUR OFFICE.

Previous Names Used Since 1975:

•The applicant must list any and all full legal names that they have ever had since 1975. This includes maiden names, nicknames, aliases and also known as (aka) names.

Previous Addresses Since 1975:

•List all addresses where the applicant has resided since 1975. The applicant can attach an additional sheet of paper with all of the addresses listed if necessary. If the applicant cannot remember the exact mailing addresses since 1975, filling in as much information as possible about the location is acceptable.

Household Members:

•Include anyone that the applicant lived with since 1975 (parents, guardians, siblings, children, spouse (ex), paramour, friends, etc.). In addition, include the household member’s relationship to the applicant, their age (to the best of your knowledge) and their gender. If the applicant was under the age of 18 in 1975, this section MUST include the applicant’s PARENT(S) or GUARDIAN(S). If this section is left blank, the application will be rejected and returned to the applicant.

Signature:

• Applications MUST be signed and dated. Applications that are not signed and dated will be rejected and returned to the applicant.

CHILDLINE USE ONLY:

• Please DO NOT WRITE in this section. This is for CHILDINE staff only.

Additional Information:

Applicants can visit https://www.compass.state.pa.us/CWIS for more information about submitting the child abuse certification online or to register for a business/organization account.

CY 113 12/15

Get Pa Child Abuse History Clearance PDF Form

Form Characteristics

Fact Name Detail
Certification Fees A payment of $13.00 is required for certifications requested for non-volunteer purposes or if a volunteer’s previous certification was obtained over 57 months ago.
Free Volunteer Certification Individuals volunteering with children can obtain their certification free of charge once every 57 months.
Application Submission Applications must be sent to the ChildLine and Abuse Registry at the Pennsylvania Department of Human Services, Harrisburg.
Completion Requirements To avoid processing delays, applicants must submit fully completed and legible forms. Incomplete or unclear applications will be returned.
Contact Information For questions, applicants can contact ChildLine at 717-783-6211 or toll-free at 1-877-371-5422.
Legal Foundation The process is governed by Pennsylvania child protection laws, specifically 23 Pa.C.S. §§ 6336 and 6344, amongst others.

Guidelines on Utilizing Pa Child Abuse History Clearance

Completing the Pennsylvania Child Abuse History Clearance form requires attention to detail and accuracy to ensure a smooth application process. By adhering to the instructions outlined below, you can effectively navigate each section and minimize the chances of your application being returned due to errors or omissions.

  1. Obtain the Form: Start by downloading or printing the Pennsylvania Child Abuse History Certification application from the official website.
  2. Type or Print Clearly: Fill out the form using black or blue ink. Your entries should be clear and legible.
  3. Choose the Purpose of Certification: Mark one box that best represents the reason for your application, such as foster parent or volunteer. Do not select more than one.
  4. Complete Applicant Demographic Information: Include your full name, Social Security number (optional but recommended), gender, date of birth, and age. Ensure not to use initials for your name.
  5. Address Information: Provide your home address, mailing address (if different), and any other address if applicable. This information is crucial for where results will be sent.
  6. Contact Information: Fill in your home, work, or mobile phone numbers and an email address for further communication.
  7. List Previous Names: Include any names you have used since 1975, such as maiden names or aliases.
  8. List Previous Addresses: Document all addresses where you have lived since 1975. If there are many, feel free to use extra sheets to ensure completeness.
  9. Household Members: List all individuals who have lived with you at any time since 1975, providing their relationship to you, age, and gender.
  10. Read and Affirm Accuracy: Sign and date the application, affirming that the information provided is accurate to the best of your knowledge.
  11. Include Payment: If applying for non-volunteer purposes, enclose a $13.00 check or money order made out to the Pennsylvania Department of Human Services. If applicable, provide a payment authorization code from your organization instead.
  12. Submit the Application: Mail the completed form along with any necessary payments or additional documents to ChildLine and Abuse Registry, PA Department of Human Services, P.O. Box 8170, Harrisburg, PA 17105-8170.

Once your application is submitted, it typically takes around 14 days to process, during which the department will conduct a thorough background check. You are encouraged to keep a copy of your completed application for your records. If there are any questions or concerns during the process, contacting the provided phone numbers will offer assistance and clarification.

What You Should Know About This Form

What is the Pennsylvania Child Abuse History Clearance form used for?

The Pennsylvania Child Abuse History Clearance form is essential for individuals seeking certification related to child welfare. This includes foster parents, prospective adoptive parents, school employees, and volunteers who have direct contact with children. The clearance helps ensure the safety and well-being of children in various programs and services across the state.

Who needs to submit this clearance form?

Anyone applying for a position or role that involves direct contact with children is required to submit this form. This includes volunteers, employees of child care services, and individuals residing with foster parents or licensed child-care providers.

How much does it cost to obtain this clearance?

The fee is $13.00 for those obtaining the certification for non-volunteer purposes. However, if you are volunteering and have not obtained a certification free of charge within the last 57 months, you can receive the clearance at no cost. Payment can be made via check or money order, but cash is not accepted.

How long does it take to receive the certification?

Once the application is received by the ChildLine and Abuse Registry, you can expect your certification results to be mailed within 14 days. Properly completed applications help expedite this process.

What happens if my application is incomplete?

If the application is incomplete or illegible, or if it is submitted without the correct fee, it will be returned unprocessed. To avoid delays, ensure all information is filled out clearly and accurately.

Can I apply for this clearance online?

Yes, you can apply for the Pennsylvania Child Abuse History Clearance online. For detailed instructions on submitting your request electronically, visit the Child Welfare Information System website.

What information do I need to provide on the application?

Your application must include your full legal name, social security number, date of birth, address history, household members, and various personal details. Make sure to provide accurate and complete information as this can affect processing times.

Is my social security number required?

While providing your social security number is voluntary, not including it may delay your application processing. It aids in searching the statewide database for any child abuse allegations.

How will I know when my certification is ready?

Results will be mailed to the address provided on your application. If you provided an email address, you may also receive updates, though no confidential information will be communicated via email.

What should I do if I have questions about my application?

If you have questions or need assistance, you can contact the ChildLine and Abuse Registry at 717-783-6211 or toll-free at 1-877-371-5422. They will be able to guide you through any concerns.

Common mistakes

When completing the Pennsylvania Child Abuse History Clearance form, applicants often make mistakes that can delay the processing of their certification. One common error involves illegible writing. The form explicitly instructions individuals to type or print clearly in ink. If the handwriting is difficult to read, staff processing the applications may struggle to interpret the information, leading to potential rejections or delays.

Another frequent mistake is the incomplete application. Each section of the form must be filled out thoroughly. Missing information regarding names, addresses, or contact details can cause significant setbacks. Applications that are not fully completed will simply be returned unprocessed. It's crucial to double-check every part before submission.

People also sometimes check more than one box under the purpose of certification. The form requires applicants to check one box only, as each box corresponds to a specific purpose; selecting multiple purposes can lead to confusion and rejection of the application. Understanding the distinctions between categories is essential for successful completion.

Payment-related errors constitute yet another pitfall. Specifically, applicants must ensure they enclose an appropriate payment method when submitting the application for non-volunteer purposes. Common mistakes include sending cash or forgetting to include payment altogether. If the payment is insufficient or incorrectly submitted, the application will be returned.

Failure to provide the Social Security number can complicate the process. While disclosure is noted as voluntary, omitting this information may prolong processing times, as the certifying authority might not be able to conduct a complete background check. Providing this information helps streamline the process and avoids unnecessary delays.

Lastly, many applicants neglect to include a signature and date. The form requires the applicant's affirmation that the information is accurate, which necessitates a signature. Without a signature and date, the application may be classified as incomplete and subsequently sent back to the applicant.

Documents used along the form

When seeking a Pennsylvania Child Abuse History Clearance, it’s crucial to be aware of additional forms and documents that may be necessary. These documents can help ensure a smooth application process and may be required based on your specific circumstances. Below is a list of relevant forms that are often used alongside the Child Abuse History Clearance form.

  • Criminal Record Check: This document verifies whether an individual has any criminal history. It's frequently required for those who work with children or in vulnerable populations.
  • Foster Care Application: If applying to become a foster parent, this application outlines your qualifications and intentions. It provides critical information about your home environment, caregiving experience, and readiness to provide foster care.
  • Consent/Release of Information Form: This form grants permission for agencies to share your background check information with a designated third party. This is important if your results need to be sent directly to an organization rather than your home address.
  • Adoption Application: Intended for prospective adoptive parents, this document serves to formally apply to adopt a child, including background checks and assessments of suitability as a parent.
  • Child Care Certification Application: For individuals looking to provide licensed child care services, this form confirms qualification and adherence to state regulations regarding child care providers.
  • Volunteer Registration Form: This document registers individuals who wish to volunteer in child-focused organizations, ensuring that background checks are conducted for safety purposes.
  • Proof of Employment or Affiliation: For certain applications, providing documentation to prove employment status or affiliation with an organization may be required. This can include pay stubs, offer letters, or organizational membership cards.

Being prepared with these documents can expedite your application and help avoid delays. Ensure that all forms are filled out accurately to facilitate a smooth approval process. If you have any questions regarding these documents, contact the appropriate agency for guidance.

Similar forms

The Pennsylvania Child Abuse History Clearance form has similarities with several other important documents. Understanding these comparisons can help individuals navigate the processes related to child safety and background checks more effectively. Below is a list of documents that share similarities with the Pennsylvania Child Abuse History Clearance form:

  • FBI Criminal Background Check: Like the Child Abuse Clearance form, the FBI criminal background check determines if a person has a history of criminal behavior. It is often required for those working with children, ensuring that individuals in positions of trust have no disqualifying offenses.
  • Pennsylvania State Police Criminal Record Check: This document is similar as it involves a thorough search of criminal history. Just like the Child Abuse Clearance, it aims to assess whether an applicant is fit to work or volunteer with children.
  • National Sex Offender Registry Check: This document checks for registered sex offenders and is crucial in protecting vulnerable populations. It serves a purpose akin to the Child Abuse History Clearance by ensuring that individuals interacting with minors are not listed as offenders.
  • Department of Motor Vehicles (DMV) Driving Record Check: While primarily focused on driving behaviors, it can highlight patterns of irresponsible or dangerous conduct. Like the Child Abuse Clearance, it assesses the trustworthiness of an individual within the context of their responsibilities, particularly if they will be transporting children.

Dos and Don'ts

Do's:

  • Type or print clearly in ink to avoid any confusion.
  • Enclose a $13.00 money order or check for non-volunteer certification applications.
  • Check only one purpose for certification to prevent processing errors.
  • Provide a valid social security number to expedite your application.
  • List all previous names and addresses accurately since 1975.
  • Make sure to sign and date the application to avoid rejection.
  • Contact ChildLine if there are questions at 717-783-6211 or 1-877-371-5422.
  • Ensure all household members are listed to comply with requirements.

Don'ts:

  • Do not send cash as payment.
  • Do not leave any sections of the application blank.
  • Do not check more than one box for purpose of certification.
  • Do not submit postage paid return envelopes as results will not be sent this way.
  • Do not send applications without the correct fee or payment authorization code.
  • Do not use initials for the names; full legal names are required.
  • Do not submit without a signature and date as this will lead to rejection.
  • Do not forget to include a contact phone number or email for any inquiries.

Misconceptions

  • Misconception 1: The certification is only necessary for individuals who work directly with children.

    • This is not true. Even individuals residing in the homes of foster parents or licensed child-care providers need this certification if they are 18 years or older. This ensures the safety of children in a variety of settings.

  • Misconception 2: It is always free to obtain the certification.

    • While certification for volunteers having direct contact with children can be obtained free of charge once every 57 months, other applicants may need to pay a fee of $13. This applies to those seeking certification for non-volunteer purposes or if they have not received a free certification within the specified timeframe.

  • Misconception 3: Personal checks or cash can be used for payment.

    • Payments should be made through a money order or check payable to the Pennsylvania Department of Human Services. Cash is not accepted, which is an important detail to consider when submitting your application.

  • Misconception 4: The application process is quick and does not require much detail.

    • In fact, providing complete and accurate information is essential. Incomplete applications can be returned unprocessed, causing potentially significant delays. Detailed information about previous names and addresses since 1975 is particularly important.

Key takeaways

Key Takeaways for Filling Out the PA Child Abuse History Clearance Form:

  • Complete the form using clear and legible ink handwriting or by typing. Incomplete or illegible submissions will be returned without processing.
  • Enclose a payment of $13.00 via money order or check payable to the Pennsylvania Department of Human Services unless you are applying as a volunteer with direct contact and have not previously obtained a certification in the last 57 months.
  • Ensure that you check the appropriate purpose of certification, as only one box may be selected. Failing to do so can cause delays or rejection of the application.
  • All sections, especially applicant demographic information and previous addresses, must be filled out accurately to prevent processing issues.
  • Applications must be signed and dated. Any form lacking a signature will be rejected, leading to further delays.

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