Before a determination is made, I understand that I will be afforded a reasonable amount of time to challenge the completeness and accuracy of the record through the procedures established by the Department of Human Services, Office of Licensing as well as contacting the Utah Bureau of Criminal Identification (Utah Criminal History Results), the State Identification Bureau (SIB) associated with any results that are outside of Utah, or the Federal Bureau of Investigation (Nationwide Criminal History Response Information). \par \tab \hich\af5\dbch\af31505\loch\f5 (iii) the Department of Human Services' Division of Aging and Adult Services vulnerable adult abuse, neglect, or exploitation database described \hich\af5\dbch\af31505\loch\f5 in Section 62A-3-311.1; Initiate your screening by submitting the appropriate application: Please direct inquiries about fingerprinting, Utah criminal records (including expungement or correction procedures) to: Utah Department of Public Safety, Bureau of Criminal Identification (BCI), 3888 West 5400 South Employment Background Checks Forms - DPS - Criminal Identification (BCI) {\fbiminor\f31578\fbidi \froman\fcharset238\fprq2 Times New Roman CE;}{\fbiminor\f31579\fbidi \froman\fcharset204\fprq2 Times New Roman Cyr;}{\fbiminor\f31581\fbidi \froman\fcharset161\fprq2 Times New Roman Greek;} DACS Information Worksheet (for use by foster parents and other adults living in foster homes) Background Screening Application - DCFS Foster/Kinship Respite Providers only. This includes foster care, proctor care, professional parent care and adoption for children in custody of a child welfare system, as well as private foster care and refugee foster care. \lsdpriority49 \lsdlocked0 List Table 4 Accent 5;\lsdpriority50 \lsdlocked0 List Table 5 Dark Accent 5;\lsdpriority51 \lsdlocked0 List Table 6 Colorful Accent 5;\lsdpriority52 \lsdlocked0 List Table 7 Colorful Accent 5; 2-35-8(1)(a), the department may deny clearance based on: \par \tab \hich\af5\dbch\af31505\loch\f5 (a) a covered employer, or \par \tab \hich\af5\dbch\af31505\loch\f5 In addition: \lsdsemihidden1 \lsdlocked0 toc 3;\lsdsemihidden1 \lsdlocked0 toc 4;\lsdsemihidden1 \lsdlocked0 toc 5;\lsdsemihidden1 \lsdlocked0 toc 6;\lsdsemihidden1 \lsdlocked0 toc 7;\lsdsemihidden1 \lsdlocked0 toc 8;\lsdsemihidden1 \lsdlocked0 toc 9; Fax: (850) 487-0470. \par \tab \hich\af5\dbch\af31505\loch\f5 (d) a hospice that provides living quarters as part of its services. It depends on what the charges are, how long ago they occurred and other considerations, Charges will be fairly assessed by the Office of Licensing as described in state law, A licensed program shall not disclose screening results except as authorized by Utah or federal law, Please allow two weeks for processing and results of your background screening, If after two weeks you have not received results, you may contact the Office of Licensing for an update by emailing, For all other inquiries please call our main line (801) 538-4242 or call your licensor or screening technician directly, Legibly complete and sign and date an application form (see above) for your appropriate area, Submit paperwork to your Background Screening Agent for identification, verification and submission to the Office of Licensing. DAR File No. 43144 (Rule R380-300), 2018-17 Utah Bull. (09/01/2018) \par \tab \hich\af5\dbch\af31505\loch\f5 (11) "Engage" means to obtain one's services: \par \tab \hich\af5\dbch\af31505\loch\f5 (16) "Residential setting" means a place provided by a cov\hich\af5\dbch\af31505\loch\f5 ered provider: \par \tab \hich\af5\dbch\af31505\loch\f5 (a) means a hospital that is certified to provide long-term care services under the provisions of 42 U.S.C. ividual disagrees with the information provided, the individual may challenge the information through the appropriate agency. This includes SAS & DSPD Certified Providers. If the applicant already has a RapBack subscription in DACS, the system will allow the screening agent to link to that application without paying new fees. As the applicant, you are responsible for providing this fee at the time of the live scan fingerprint appointment, The Rap Back system checks state, regional and national databases for criminal records, By submitting an application, you give consent for the Office of Licensing to monitor all relevant databases for as long as you remain licensed or associated with a licensee, The Office of Licensing will issue a screening clearance or denial, according to standards and procedures outlined in, If you receive clearance on your screening, your application will be returned to the background screening agent that submitted it. I hereby authorize (enter name of requesting agency) Division Public and Behavioral Health, to submit a set of my fingerprints to the Nevada Department Public Safety, Records Bureau for the purpose of accessing and reviewing State of Nevada and FBI criminal history records that may pertain to me. Principal Purpose: Certain determinations, such as employment, licensing, and security clearances, may be predicated on fingerprint-based background checks. \par \tab \hich\af5\dbch\af31505\loch\f5 (e) a personal care agency. \par \tab \hich\af5\dbch\af31505\loch\f5 (b) a small health care facility; \par \tab \hich\af5\dbch\af31505\loch\f5 (b) As required by Utah Code Subsection 26-21-204, if an individual or covered individual has a warrant for arrest or an arrest for any of the identified offenses in R43\hich\af5\dbch\af31505\loch\f5 \par \tab \hich\af5\dbch\af31505\loch\f5 (h) licensing and certification records of individuals licensed or certified by the Division of Occupat\hich\af5\dbch\af31505\loch\f5 ional and Professional Licensing under Title 58, Occupations and Professions; and 4. \lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Table Columns 4;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Table Columns 5;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Table Grid 1;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Table Grid 2; Email: dhslicensing@utah.gov, HotlinesAbuse/Neglect of Seniors and Adults with Disabilities {\*\cs10 \additive Default Paragraph Font;}{\*\ts11\tsrowd\trftsWidthB3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\trcbpat1\trcfpat1\tblind0\tblindtype3\tsvertalt\tsbrdrt\tsbrdrl\tsbrdrb\tsbrdrr\tsbrdrdgl\tsbrdrdgr\tsbrdrh\tsbrdrv Signs a criminal background screening authorization form which must be available for review by the department; and . I understand that my personal information including name, DOB, SSN and fingerprints will be used for the purpose of . \par \par \tab \hich\af5\dbch\af31505\loch\f5 (a) means an individual: PDF Policies and Procedures for Conducting Criminal Background Checks - Utah Health, Administration. If the individual is not eligible for cl \par \tab \hich\af5\dbch\af31505\loch\f5 (4) Review of Relevant Information \lsdsemihidden1 \lsdunhideused1 \lsdlocked0 HTML Top of Form;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 HTML Bottom of Form;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Normal (Web);\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 HTML Acronym; The DPS must receive the authorization form with the "original" signature. 1-800-371-7897 National Suicide Prevention Lifeline Receiving Results: Once the Office reviews this information a determination will be made per 62A-2-120 and emailed from the Office to the email address provided from the non-licensed entity on the Background Screening Application. 000000000000000000009d0a00007468656d652f7468656d652f5f72656c732f7468656d654d616e616765722e786d6c2e72656c73504b050600000000050005005d010000980b00000000} 6e22206267313d226c743122207478313d22646b3122206267323d226c743222207478323d22646b322220616363656e74313d22616363656e74312220616363 b48cc799fc0d91f134462b381daafb4a492472d591f0564cc0a1911e76ea5678ba4e4ed9223becacd7d5c16656590592e5782d2cc6e1a04a66e856bb3cc02bd4 \lsdpriority60 \lsdlocked0 Light Shading Accent 3;\lsdpriority61 \lsdlocked0 Light List Accent 3;\lsdpriority62 \lsdlocked0 Light Grid Accent 3;\lsdpriority63 \lsdlocked0 Medium Shading 1 Accent 3;\lsdpriority64 \lsdlocked0 Medium Shading 2 Accent 3; No appeal is available if you are denied for failure to provide required information, If you close your foster care license, it is your or the screening agents responsibility to inform the Office of Licensing for removal from the ongoing Rap Back system, You are required to disclose all criminal charges, including pending charges, and all supported or substantiated findings of abuse, neglect or exploitation. L. 92-544, Presidential Executive Orders, and federal. SUBJECT: Memorandum Report: State Requirements for Conducting Background Checks on Hom e Health Agency Employees, OEI-07-14-00131 In response to a congressional request, the Office oflnspector General (OIG) initiated two . This action is part . \par }}{\*\aftncn \ltrpar \pard\plain \ltrpar\ql \li0\ri0\nowidctlpar\wrapdefault\faauto\rin0\lin0\itap0\pararsid14438297 \rtlch\fcs1 \af5\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\loch\af5\hich\af5\dbch\af31505\cgrid\langnp1033\langfenp1033 { Utah Admin. Code R432-35-5 - Covered Contractor - DACS Process A background check authorization form is basically the written consent for a background check needed by your potential employer. Health and Human Services Consolidation Information. employer may choose to submit the Employer Background Screening Request along with a Worker Registration form, photocopy of social security card and required registration fee, by mail to the Missouri Department of Health and Senior Services, Fee Receipts Unit, P.O. Utah Domestic Violence Some employment authorization documents issued by DHS include but are not limited to Form I-94 Arrival/Departure Record issued to asylees or work-authorized nonimmigrants (for example, H-1B nonimmigrants) because of their immigration status, Form I-571, Refugee Travel Document (PDF), an unexpired Form I-327, Reentry Permit , Form N-560 . If you choose not to use a DCFS Live Scan, you may submit two fingerprint cards. \lsdsemihidden1 \lsdunhideused1 \lsdqformat1 \lsdpriority39 \lsdlocked0 TOC Heading;\lsdpriority41 \lsdlocked0 Plain Table 1;\lsdpriority42 \lsdlocked0 Plain Table 2;\lsdpriority43 \lsdlocked0 Plain Table 3;\lsdpriority44 \lsdlocked0 Plain Table 4; The following form is for those individuals seeking to obtain a copy of their own Utah criminal history record. . Child Abuse/Neglect \par \tab \hich\af5\dbch\af31505\loch\f5 (4) A covered contractor may provisionally supply a covered individual to a covered provider while clearance is pendin\hich\af5\dbch\af31505\loch\f5 g. \par \tab \hich\af5\dbch\af31505\loch\f5 The department may impose civil monetary penalties in accordance with Title 26, Chapter 23, Utah Health Code Enforcement Provisions and Penalties, if th\hich\af5\dbch\af31505\loch\f5 \par \tab \hich\af5\dbch\af31505\loch\f5 (a) for residents to live as part of the services provided by the covered provider; and How to get a pre-employment background check. ffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffff DOC CONSENT FOR BACKGROUND CHECK AND - Hawaii \lsdsemihidden1 \lsdunhideused1 \lsdlocked0 line number;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 page number;\lsdsemihidden1 \lsdlocked0 endnote reference;\lsdsemihidden1 \lsdlocked0 endnote text; All U.S. employers must properly complete Form I-9 for each individual they hire for employment in the United States. \par \tab \hich\af5\dbch\af31505\loch\f5 (i) types and number; \rtlch\fcs1 \af5 \ltrch\fcs0 \insrsid7565795 \chftnsepc 1-800-371-7897 Section R432-35-4 - Covered Provider - DACS Process (1) Covered providers shall enter required information into DACS to initiate a clearance for each covered individual prior to issuance of a provisional license, license renewal or engagement as a covered individual. Criminal Background Screening Authorization Form. This form must be completed and signed by the applicant. \lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Body Text 2;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Body Text 3;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Body Text Indent 2;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Body Text Indent 3; \lsdsemihidden1 \lsdunhideused1 \lsdlocked0 footer;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 index heading;\lsdqformat1 \lsdlocked0 caption;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 table of figures; {\fdbminor\f31559\fbidi \froman\fcharset204\fprq2 Times New Roman Cyr;}{\fdbminor\f31561\fbidi \froman\fcharset161\fprq2 Times New Roman Greek;}{\fdbminor\f31562\fbidi \froman\fcharset162\fprq2 Times New Roman Tur;} \par }{\rtlch\fcs1 \ab\af5 \ltrch\fcs0 \b\expnd0\expndtw-3\insrsid14438297 \hich\af5\dbch\af31505\loch\f5 R432-35-2. : 43003 Filed: 06/15/2018 10:31:45 AM RULE ANALYSIS Purpose of the rule or reason for the change: \lsdsemihidden1 \lsdunhideused1 \lsdlocked0 index 3;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 index 4;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 index 5;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 index 6; (1) The Department may conduct a background screening on current employees based on division's background screening guidelines determined by risk associated with the employees' work responsibilities. Child Abuse/Neglect I need to obtain a copy of my nationwide criminal history from the FBI. Crisis Line & Mobile Outreach Team If you believe your Identity History Summary contains inaccurate or incomplete information, you have two options for requesting a change or correction: Option 1: Contact the agency or agencies that submitted the information to the FBI. 02000000180000004d73786d6c322e534158584d4c5265616465722e362e3000000000000000000000060000 \lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Normal Indent;\lsdsemihidden1 \lsdlocked0 footnote text;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 annotation text;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 header; }{\rtlch\fcs1 \af5 \ltrch\fcs0 \expnd0\expndtw-3\insrsid14438297 The NICS conducts background checks on people who want to own a firearm or explosive, as required by law. \par \tab \hich\af5\dbch\af31505\loch\f5 (d) a home health agency; or }{\rtlch\fcs1 \af5 \ltrch\fcs0 \expnd0\expndtw-3\insrsid14438297 ss Clearance System to run a verification report and verify that each covered individual's information is correct, including: The applicant must also complete the Medical Cannabis Production Establishment Criminal Background Receipt form. {\fbimajor\f31544\fbidi \froman\fcharset178\fprq2 Times New Roman (Arabic);}{\fbimajor\f31545\fbidi \froman\fcharset186\fprq2 Times New Roman Baltic;}{\fbimajor\f31546\fbidi \froman\fcharset163\fprq2 Times New Roman (Vietnamese);} Form I-9 Acceptable Documents | USCIS Utah Admin. Code R380-300-4 - Background Screening Process - Current fa3528a6243ddf43d7c25673b85d6d0159327aec8477c360d26ee4ca4b144443115d6a8a254be5a1584bd00bc6270050408a24493db959e1259a43140f112567 (2) If the Department determines an individual is not eligible for direct patient access, based on information obtained through the Direct Access Clearance System, the Department shall send a Notice of Agency Action to t\hich\af5\dbch\af31505\loch\f5 Executive Order 9397 also asks Federal agencies to use this number to help identify individuals in agency records. \par \tab \hich\af5\dbch\af31505\loch\f5 (c) is\hich\af5\dbch\af31505\loch\f5 not a licensed health care facility within the state. Option 2: Send a written challenge request to the FBI. (2) The covered provider must ensure that the engaged covered individual: (a) Signs a criminal background screening . b17d4e9cd131584756689f604cd1255a60ec3dfbdcc160c05696cd4bd20f62c82ac7d815580f901dabea3dc5027a25d5dcece7c91322ac909de2881de073bad9 he covered employer and the individual explaining the action and the individual's right of appeal as defined in R432-30. The Utah Department of Health and Human Services is now one agency. \par \tab \hich\af5\dbch\af31505\loch\f5 (viii) housekeeping; \lsdsemihidden1 \lsdunhideused1 \lsdlocked0 List Continue 5;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Message Header;\lsdqformat1 \lsdpriority11 \lsdlocked0 Subtitle;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Salutation; Pursuant to the Federal Privacy Act of 1974 (5 USC 552a), the requesting agency is responsible for informing you whether disclosure is mandatory or. \s30\ql \fi-720\li720\ri0\sl240\slmult0\nowidctlpar\tqr\tldot\tx9360\wrapdefault\hyphpar0\faauto\rin0\lin720\itap0 \rtlch\fcs1 \af5\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\loch\f5\hich\af5\dbch\af31505\cgrid\langnp1033\langfenp1033 Prints will remain active for 60 days to allow for re-employment in a licensed setting. 1-888-222-2542 {\fhimajor\f31502\fbidi \fswiss\fcharset0\fprq2{\*\panose 020f0302020204030204}Calibri Light;}{\fbimajor\f31503\fbidi \froman\fcharset0\fprq2{\*\panose 02020603050405020304}Times New Roman;} Each screening agent has permissions to link a cleared application to as many sites under that licensed organization as will be applicable for that applicant. {\f870\fbidi \froman\fcharset204\fprq2 Cambria Math Cyr;}{\f872\fbidi \froman\fcharset161\fprq2 Cambria Math Greek;}{\f873\fbidi \froman\fcharset162\fprq2 Cambria Math Tur;}{\f876\fbidi \froman\fcharset186\fprq2 Cambria Math Baltic;} \par \tab \hich\af5\dbch\af31505\loch\f5 (a) by employmen\hich\af5\dbch\af31505\loch\f5 t; \lsdpriority65 \lsdlocked0 Medium List 1;\lsdpriority66 \lsdlocked0 Medium List 2;\lsdpriority67 \lsdlocked0 Medium Grid 1;\lsdpriority68 \lsdlocked0 Medium Grid 2;\lsdpriority69 \lsdlocked0 Medium Grid 3;\lsdpriority70 \lsdlocked0 Dark List; \par Background Screening Application - Youth Transport Company employeees only. Human Services. \lsdsemihidden1 \lsdunhideused1 \lsdqformat1 \lsdpriority9 \lsdlocked0 heading 8;\lsdsemihidden1 \lsdunhideused1 \lsdqformat1 \lsdpriority9 \lsdlocked0 heading 9;\lsdsemihidden1 \lsdlocked0 index 1;\lsdsemihidden1 \lsdlocked0 index 2; \s21\ql \fi-720\li720\ri720\sb480\sl240\slmult0\nowidctlpar\tqr\tldot\tx9360\wrapdefault\hyphpar0\faauto\rin720\lin720\itap0 \rtlch\fcs1 \af5\afs24\alang1025 \ltrch\fcs0 \par \tab \hich\af5\dbch\af31505\loch\f5 (a) Signs a criminal background screening authorization form which\hich\af5\dbch\af31505\loch\f5 must be available for review by the department; and }{\rtlch\fcs1 \af5 \ltrch\fcs0 \expnd0\expndtw-3\insrsid14438297 Additional Information: The requesting agency and/or the agency conducting the application investigation will provide you additional information pertinent to the specific circumstances of this application, which may include identification of other authorities, purposes, uses, and consequences of not providing requested information. How to Request a Background Check - University of Texas at Austin }{\field{\*\fldinst {\rtlch\fcs1 \af5 \ltrch\fcs0 \expnd0\expndtw-3\insrsid14438297 \hich\af5\dbch\af31505\loch\f5 PRIVATE }{ 26-21-204, if an individual or covered individual has been convicted, has pleaded no contest, or is subject to a plea in abeyance or diversion agreement, for the following offenses, they may not have direct patient access: \par \tab \hich\af5\dbch\af31505\loch\f5 (i) any felony or class A convi\hich\af5\dbch\af31505\loch\f5 ction under Utah Code. Your fingerprints and associated information/biometrics may be provided to the employing, investigating, or otherwise responsible agency, and/or the FBI for the purpose of comparing your fingerprints to other fingerprints in the FBIs Next Generation Identification (NGI) system or its successor systems (including civil, criminal, and latent fingerprint repositories) or other available records of the employing, investigating, or otherwise responsible agency. Crisis Line & Mobile Outreach Team 000000000000d60200007468656d652f7468656d652f7468656d65312e786d6c504b01022d00140006000800000021000dd1909fb60000001b01000027000000 c7060abb0884a4eff7a93dfeae8bf9e194e720169aaa06c3e2433fcb68e1763dbf7f82c985a4a725085b787086a37bdbb55fbc50d1a33ccd311ba548b6309512 This payment authorizes a subscription to the FBIs Rap Back System which continually monitors all fingerprint based criminal records in real time. 1-888-421-1100 \lsdqformat1 \lsdpriority20 \lsdlocked0 Emphasis;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Document Map;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Plain Text;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 E-mail Signature; \par How do I Renew my Concealed Firearm Permit? Payment for both the license application fee and the FBI/BCI fingerprint fee of $28.25 ($13.25 FBI/$15 BCI) must be made by credit card during the online license application process. You may be eligible to request a conditional clearance per R501-14-7-2if: The following information is required in order to request a conditional approval: If you meet the above criteria, you may request a conditional approval here. Background Checks - Individual Providers | DSHS - Washington \par \tab \hich\af5\dbch\af31505\loch\f5 (vi) the List of Excluded Individuals and Entities database maintained by the United States Department of Health and Human Services' Office of Inspector General.
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