89 Ill. Adm. Code 4150.415.180
Out-of-State Child Abuse and Neglect Findings Request
TITLE 89: SOCIAL SERVICES
CHAPTER III: DEPARTMENT OF CHILDREN AND FAMILY SERVICES
PART 415 RELATIVE HOME CERTIFICATION
SECTION 415.180 OUT-OF-STATE CHILD ABUSE AND NEGLECT FINDINGS REQUEST
Section 415.180
Out-of-State Child Abuse and Neglect Findings Request
A
standardized form shall be used to check for child abuse and neglect findings
in another state. Only a Department-issued official form with a CFS number in
the top left-hand corner or a form issued and required by the receiving state
shall satisfy the requirements of this Part. The Department form shall consist
of the following elements:
a) The title, which will be: "Out-of-State Child Abuse and
Neglect Findings Request".
b) Instructions
for the form, which shall include the following text:
"Use
this form to check whether an individual has substantiated findings of child
abuse or neglect in another state. This form must be completed if a relative
caregiver applicant, or another adult living in their home, has lived out of
state in the past five years. Complete one form for each individual for each
state they have resided in."
c) A section entitled, "Section 1: Applicant Information",
which requests the following information:
1) First
name;
2) Middle
name;
3) Last
name;
4) Other
names used including birth name and previously married name;
5) Date
of birth;
6) Social
security number or tax ID number (ITIN); and
7) Past
addresses where the applicant has lived in the past 5 years.
d) A section entitled "Section 2: Requesting Agency",
which requests the following information:
1) Agency
name;
2) Staff
name;
3) Staff
title;
4) Centralized
email;
5) Staff
phone number; and
6) Request
date.
e) A
section entitled "Section 3: Results", which requests the following
information:
1) Does the applicant have a record of substantiated child abuse
or neglect and if so refers to an attached record.
2) Agency
name;
3) Staff
initials; and
4) Date.