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Common mistakes
Filling out the Pennsylvania Child Abuse History Clearance form can be straightforward, but many make common mistakes that can delay the process. One frequent error is not typing or printing clearly. The instructions specify that applicants must use ink and ensure legibility. Illegible forms are often returned unprocessed.
Another mistake involves incorrect payment. If you are applying for non-volunteer purposes or if you have already received a free certification within the last 57 months, a fee of $13.00 is required. Some applicants mistakenly send cash, which is not accepted. Always use a money order or check made out to the Pennsylvania Department of Human Services.
Many applicants overlook the requirement to check only one box in the "Purpose of Certification" section. Checking multiple boxes can lead to confusion and rejection of the application. It's essential to select the box that accurately reflects your situation, whether you are a foster parent, prospective adoptive parent, or volunteer.
Providing incomplete demographic information is another common issue. Applicants must include their full legal name, social security number, date of birth, and age. Initials are not acceptable for the name section. Leaving any of this information blank can cause significant delays.
Previous names and addresses must be filled out accurately since 1975. Many applicants either forget to include all names or do not list all addresses. This omission can lead to complications in processing the application. Ensure you list every name and address, even if partial, and attach additional pages if necessary.
Household member information is often neglected. Applicants must include everyone they have lived with since 1975, including parents and guardians. Failing to provide this information can result in rejection. Be thorough in listing relationships, ages, and genders.
Another mistake is not signing or dating the application. The form must be signed and dated by the applicant; otherwise, it will be returned unprocessed. This step is crucial and often overlooked.
Some individuals forget to include the Consent/Release of Information Authorization form when applicable. If this form is not attached, results will be mailed to the applicant's home address instead of a third party, which may not be the desired outcome.
Lastly, applicants sometimes fail to provide contact information. It's important to include a home, work, or mobile phone number and an email address. This information is vital for any follow-up questions and ensures smooth communication throughout the process.
Dos and Don'ts
When filling out the Pennsylvania Child Abuse History Clearance form, there are important guidelines to follow. Here are some do's and don'ts to ensure your application is processed smoothly:
- Do type or print clearly in ink.
- Do include a money order or check for non-volunteer applications.
- Do check only one box for the purpose of certification.
- Do provide your full legal name without initials.
- Don't send cash as payment.
- Don't leave any sections of the application blank.
- Don't forget to sign and date your application.
- Don't submit postage-paid return envelopes for results.
Fill out Common Documents
Docketing Statement Civil Pennsylvania - Distinct categories including adoption and paternity are outlined for clarity in the type of case being appealed.
Transfer Car Title to Family Member - A certification at the end confirms that all information provided is accurate.
Similar forms
The Pennsylvania Child Abuse History Clearance form shares similarities with the FBI Criminal Background Check. Both documents are essential for individuals working with children, as they provide a thorough examination of any criminal history. The FBI check requires fingerprints and searches national databases to identify any past criminal activity, ensuring a comprehensive review. Like the Pennsylvania form, it is often a prerequisite for employment or volunteer positions in child-related fields, emphasizing the importance of safeguarding vulnerable populations.
The Ohio Motor Vehicle Bill of Sale is a legal document that serves as proof of the transfer of ownership for a vehicle, ensuring that both parties are clear about the specifics of the transaction. Understanding how to properly complete this form is crucial for a smooth transfer process in Ohio, and you can find a helpful template through PDF Document Service.
Another document akin to the Pennsylvania Child Abuse History Clearance is the Pennsylvania State Police Criminal Record Check. This form is designed to assess an individual's criminal history within the state, focusing on offenses that may impact their suitability for working with children. Similar to the Child Abuse Clearance, it requires personal information and may be used for employment, volunteering, or fostering. Both documents aim to enhance child safety by identifying potential risks associated with applicants.
The National Sex Offender Registry (NSOR) is also comparable to the Pennsylvania Child Abuse History Clearance form. It serves as a resource for checking if an individual is listed as a sex offender, which is critical for roles involving children. Employers and organizations often consult this registry to ensure that their environments remain safe. While the Pennsylvania form specifically addresses child abuse history, the NSOR provides broader information on sexual offenses, highlighting the necessity of thorough background checks in child welfare settings.
The Child Protective Services (CPS) Background Check is another document that aligns closely with the Pennsylvania Child Abuse History Clearance. This check is conducted to identify any reports of abuse or neglect that may have been filed against an individual. Like the Pennsylvania form, it is crucial for anyone seeking to work or volunteer in child care or education. The CPS check focuses on protecting children by ensuring that those in contact with them have no history of harmful behavior.
The Employment Verification Letter serves a different purpose but is still relevant in assessing an applicant's background. This document provides proof of an individual's previous employment, which can include positions involving children. While it does not directly check for criminal history, it helps organizations understand an applicant's work history and reliability. The Pennsylvania Child Abuse History Clearance complements this by specifically addressing an applicant's suitability regarding child welfare.
The Department of Motor Vehicles (DMV) Driving Record is another document that can be relevant, especially for positions requiring transportation of children. While it primarily focuses on driving history, it can reveal patterns of irresponsible behavior that may raise concerns about an individual's ability to care for children. The Pennsylvania Child Abuse History Clearance, on the other hand, specifically targets past abuse incidents, making it a more focused tool for assessing child safety.
The Volunteer Application Form is similar in that it often requires background checks, including child abuse clearances. This form gathers information about the applicant's intent to volunteer, including their qualifications and experience. While it may not directly assess criminal history, it sets the stage for the Pennsylvania Child Abuse History Clearance to be utilized as part of the vetting process, ensuring that volunteers are suitable for working with children.
The Home Study Report is particularly relevant for prospective adoptive parents and foster parents. This document assesses the home environment and the suitability of individuals looking to provide care for children. Like the Pennsylvania Child Abuse History Clearance, it is an integral part of the approval process for those wishing to foster or adopt, ensuring that children are placed in safe and nurturing environments.
The Child Care Provider Certification is another document that parallels the Pennsylvania Child Abuse History Clearance. This certification is required for individuals who wish to operate a child care facility. It typically involves background checks, including child abuse history, to ensure the safety of children in care. Both documents work together to uphold standards in child care services and protect children from potential harm.
Lastly, the Adult Protective Services (APS) Background Check serves a similar purpose for vulnerable adults but is relevant in contexts where individuals may work with both children and adults. This document assesses any history of abuse or neglect against vulnerable populations. While the Pennsylvania Child Abuse History Clearance focuses on children, both checks emphasize the need for safety and protection for those who may be unable to advocate for themselves.
Guidelines on How to Fill Out Pa Child Abuse History Clearance
Completing the Pennsylvania Child Abuse History Clearance form is an important step in ensuring the safety and well-being of children. After filling out the form, it will be submitted to the appropriate department for processing. You can expect to receive the results within 14 days from the date your application is received.
- Gather necessary information, including your full legal name, social security number, date of birth, and current address.
- Determine the purpose of your certification and check the appropriate box on the form. Ensure you only select one box.
- If applicable, provide a payment authorization code or include a $13.00 money order or check made out to the Pennsylvania Department of Human Services.
- Fill in your demographic information clearly, including your gender and age.
- List any previous names you have used since 1975, including maiden names and aliases.
- Provide all addresses where you have lived since 1975. If you need more space, attach additional pages.
- Include information about household members who have lived with you since 1975, noting their relationship to you, age, and gender.
- Sign and date the application, affirming that the information provided is accurate.
- Do not send cash or postage-paid return envelopes. Mail the completed form to the address provided on the form.
After sending your application, it will be processed, and you will receive your certification results via mail. If you have any questions during the process, you can reach out to the provided contact numbers for assistance.
Form Preview Example
PENNSYLVANIA CHILD ABUSE HISTORY CERTIFICATION
Type or print clearly in ink. If obtaining this certification for
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
APPLICATIONS THAT ARE INCOMPLETE, ILLEGIBLE OR RECEIVED WITHOUT THE CORRECT FEE WILL BE RETURNED UNPROCESSED. IF YOU HAVE QUESTIONS CALL
PURPOSE OF CERTIFICATION (Check one box only)
Foster parent |
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Volunteer having direct volunteer contact with children |
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Prospective adoptive parent |
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If purpose is volunteer having direct volunteer contact with chil- |
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Employee of child care services |
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dren, choose SUB PURPOSE: |
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School employee governed by the Public School Code |
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Big Brother/Big Sister and/or affiliate |
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School employee not governed by the Public School Code |
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Domestic violence shelter and/or affiliate |
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Rape crisis center and/or affiliate |
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An individual 14 years of age or older applying for or holding a paid |
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Other: |
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position as an employee with a program, activity, or service |
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PA Department of Human Services Employment & Training Program |
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An individual seeking to provide |
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participant (signature required below) |
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child care facility or program |
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An individual 18 years or older who resides in the home of a foster parent |
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for children for at least 30 days in a calendar year |
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SIGNATURE OF OIM/CAO REPRESENTATIVE |
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OIM/CAO PHONE |
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An individual 18 years or older who resides in the home of a certified or |
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licensed |
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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: |
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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 |
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MIDDLE NAME |
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LAST NAME |
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SOCIAL SECURITY NUMBER |
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DATE OF BIRTH (MM/DD/YYYY) |
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Not reported |
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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
HOME ADDRESS |
MAILING ADDRESS |
OTHER ADDRESS (if Consent/Release of |
(if different from home address) |
Information Authorization form is attached) |
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ADDRESS LINE 1 |
ADDRESS LINE 1 |
ADDRESS LINE 1 |
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ADDRESS LINE 2 |
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CITY |
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STATE/REGION/PROVINCE |
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ZIP/POSTAL CODE |
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COUNTRY |
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ATTENTION |
ATTENTION |
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CONTACT INFORMATION |
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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.)
CY 113 12/15
PENNSYLVANIA CHILD ABUSE HISTORY CERTIFICATION
PREVIOUS NAMES USED SINCE 1975 (Include maiden name, nickname and aliases.)
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PREVIOUS ADDRESSES SINCE 1975 (Please list all addresses since 1975, partial address acceptable; attach additional pages if necessary.)
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(Please list everyone who lived with you at any time since 1975 to present. |
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Please include parent, guardian or the person(s) who raised you; attach additional pages as necessary.) |
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Name (First, Middle, Last) |
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Relationship |
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person(s) who raised you |
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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 #
CY 113 12/15
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
•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
(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
(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
•Check the
(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
CY 113 12/15
•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
•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
Form Information
| Fact Name | Description |
|---|---|
| Application Fee | The fee for the Pennsylvania Child Abuse History Clearance is $13.00 for non-volunteer purposes. Volunteers can obtain it free of charge once every 57 months. |
| Submission Address | Applications must be sent to ChildLine and Abuse Registry, PA Department of Human Services, P.O. Box 8170, Harrisburg, PA 17105-8170. |
| Processing Time | Results will be mailed within 14 days from the date the application is received. |
| Incomplete Applications | Applications that are incomplete, illegible, or submitted without the correct fee will be returned unprocessed. |
| Governing Law | The clearance is governed by 23 Pa.C.S. §§ 6336, 6344, 6344.1, and 6344.2. |
| Applicant Information | Applicants must provide their full legal name, Social Security number (voluntary), gender, date of birth, and current address. |
| Household Members | Applicants must list all household members since 1975, including relationships, ages, and genders. |