\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 \lsdpriority67 \lsdlocked0 Medium Grid 1 Accent 5;\lsdpriority68 \lsdlocked0 Medium Grid 2 Accent 5;\lsdpriority69 \lsdlocked0 Medium Grid 3 Accent 5;\lsdpriority70 \lsdlocked0 Dark List Accent 5;\lsdpriority71 \lsdlocked0 Colorful Shading Accent 5; ffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffff po box 144103 salt lake city, ut 84114-4103 (801) 273-2994 (800) 662-4157 toll free (801) 274-0658 fax. {\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 \tab \hich\af5\dbch\af31505\loch\f5 (2) if significant problems exist that result in actual harm to a resident, the department may impose a civil penalty of $1,050 to $10,000 per day. earance for a covered individual. The process for SD state only criminal background checks includes submitting a fingerprint card, the Authorization form, and payment for each fingerprint card submitted. who has limitations with two or more major life activities, such as caring for one's self, performing manual tasks, walking, seeing, hearing, speaking, breathing, learning, and employment. \rtlch\fcs1 \af5 \ltrch\fcs0 \expnd0\expndtw-3\insrsid14438297 {\*\datafield 0c0070686f656e697800010000}}}{\fldrslt }}\sectd \ltrsect\pgnrestart\linex0\headery1440\footery1440\sectdefaultcl\sectrsid14438297\sftnbj {\rtlch\fcs1 \af5 \ltrch\fcs0 {\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;} b17d4e9cd131584756689f604cd1255a60ec3dfbdcc160c05696cd4bd20f62c82ac7d815580f901dabea3dc5027a25d5dcece7c91322ac909de2881de073bad9 {\fbiminor\f31582\fbidi \froman\fcharset162\fprq2 Times New Roman Tur;}{\fbiminor\f31583\fbidi \froman\fcharset177\fprq2 Times New Roman (Hebrew);}{\fbiminor\f31584\fbidi \froman\fcharset178\fprq2 Times New Roman (Arabic);} \tqr\tldot\tx9360\wrapdefault\hyphpar0\faauto\rin720\lin720\itap0 \rtlch\fcs1 \af5\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\loch\f5\hich\af5\dbch\af31505\cgrid\langnp1033\langfenp1033 \sbasedon0 \snext0 toc 3;}{ After you do this, you will receive a Livescan Authorization Form to take with you when you get fingerprints done. 1-888-421-1100 \ltrch\fcs0 \insrsid7565795 \chftnsep }{\rtlch\fcs1 \af5 \ltrch\fcs0 \insrsid7565795 \par \tab \hich\af5\dbch\af31505\loch\f5 (a) Signs a criminal background screening authorization form which must be available for review by the department; and \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; (2) The Department may allow a covered individual direct patient access with conditions, until the arrest or criminal charges are resolved, if the covered individual can demonstrate the work arrangement does not pose a threat to the saf ;}{\levelnumbers\'01;}\rtlch\fcs1 \af0 \ltrch\fcs0 \hres0\chhres0 }{\listlevel\levelnfc0\levelnfcn0\leveljc0\leveljcn0\levelfollow2\levelstartat1\levelspace0\levelindent0{\leveltext\'02\'02. \lsdsemihidden1 \lsdunhideused1 \lsdlocked0 index 3;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 index 4;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 index 5;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 index 6; \lsdqformat1 \lsdpriority20 \lsdlocked0 Emphasis;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Document Map;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Plain Text;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 E-mail Signature; overed provider must submit required information to the Department to initiate and obtain a clearance prior to the issuance of the provisional license. The needs of our communities continue to change as more and more people choose to make Utah their home. }{\rtlch\fcs1 \af5 \ltrch\fcs0 \expnd0\expndtw-3\insrsid14438297 {\fhimajor\f31529\fbidi \fswiss\fcharset204\fprq2 Calibri Light Cyr;}{\fhimajor\f31531\fbidi \fswiss\fcharset161\fprq2 Calibri Light Greek;}{\fhimajor\f31532\fbidi \fswiss\fcharset162\fprq2 Calibri Light Tur;} with conditions, during an appeal process, if the covered individual can demonstrate the work arrangement does not pose a threat to the safety and health of patients or residents. Last, background screenings are required if you are seeking legal guardianship consent for youth ages 12- to 17-years-old and not living in a foster/adoptive home and not receiving services. \par \tab \hich\af5\dbch\af31505\loch\f5 (i) the List of Excluded Individuals and Entities database maintained by the United States Department of Health and Human Services' Office of Inspector General. 1-888-421-1100 After you do this, you will receive a Livescan Authorization Form to take with you when you get fingerprints done, Use this form if you provide respite care or babysitting for a foster provider and do not live in the foster home, Fill out the form completely, following the instructions on page 2 of the form, Make sure to include the name of the foster provider and licensor in the appropriate spaces and sign the form. \par \tab \hich\af5\dbch\af31505\loch\f5 (d) a home health agency; or \lsdpriority66 \lsdlocked0 Medium List 2 Accent 4;\lsdpriority67 \lsdlocked0 Medium Grid 1 Accent 4;\lsdpriority68 \lsdlocked0 Medium Grid 2 Accent 4;\lsdpriority69 \lsdlocked0 Medium Grid 3 Accent 4;\lsdpriority70 \lsdlocked0 Dark List Accent 4; 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. ss Clearance System to run a verification report and verify that each covered individual's information is correct, including: a7e7c0000000360100000b0000005f72656c732f2e72656c73848fcf6ac3300c87ef85bd83d17d51d2c31825762fa590432fa37d00e1287f68221bdb1bebdb4f c7060abb0884a4eff7a93dfeae8bf9e194e720169aaa06c3e2433fcb68e1763dbf7f82c985a4a725085b787086a37bdbb55fbc50d1a33ccd311ba548b6309512 \lsdpriority46 \lsdlocked0 Grid Table 1 Light Accent 3;\lsdpriority47 \lsdlocked0 Grid Table 2 Accent 3;\lsdpriority48 \lsdlocked0 Grid Table 3 Accent 3;\lsdpriority49 \lsdlocked0 Grid Table 4 Accent 3; \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: 1-855-323-DCFS(3237) Last, background screenings are required if you are seeking legal guardianship consent for youth ages 12- to 17-years-old and not living in a foster/adoptive home and not receiving services. Email: dhslicensing@utah.gov, HotlinesAbuse/Neglect of Seniors and Adults with Disabilities No renewals will be required for as long as the applicant is actively employed in a licensed DHS or DHS contracted agency. The agency will keep it on file and make it available as needed by the Office of Licensing, If a screening is denied, you and/or your background screening agent will be notified in writing, along with appeal procedures. \hres0\chhres0 }{\listlevel\levelnfc4\levelnfcn4\leveljc0\leveljcn0\levelfollow2\levelstartat1\levelspace0\levelindent0{\leveltext\'02\'03. \'02\'01. Pursuant to the Federal Privacy Act of 1974 (5 USC 552a), the requesting agency is responsible for informing you whether disclosure is mandatory or. \lsdpriority46 \lsdlocked0 List Table 1 Light;\lsdpriority47 \lsdlocked0 List Table 2;\lsdpriority48 \lsdlocked0 List Table 3;\lsdpriority49 \lsdlocked0 List Table 4;\lsdpriority50 \lsdlocked0 List Table 5 Dark; Rule R380-300. \par \tab \hich\af5\dbch\af31505\loch\f5 (e) Patient family members; and Once you have consent, you will need to . 2d51e252394309350d7e8264ec2239ddf0b9891b0b099e8e3065de78818570c93ce6b05ec3e90f21cdb8dd7e4a37898de4929cbb749e20c64ce4889d0f6394ac \hich\af5\dbch\af31505\loch\f5 n\hich\af5\dbch\af31505\loch\f5 existing license or deny licensure as a health care facility. I agree the Company may rely on this authorization to order background reports, including investigative consumer reports, from companies other than the Background Check Company without asking me for my authorization again as allowed by law. \par \tab \hich\af5\dbch\af31505\loch\f5 (3) If the Department denies or revokes a license, or denies direct patient access based upon arrest or criminal charges, the Department shall send a Notice of Agency Action to the covered provider and the covered 1-800-371-7897 Crisis Line & Mobile Outreach Team Screening agent will require a disclosure form to be signed and uploaded into DACS in order for OL to conduct continual monitoring of the RapBack criminal database and all regional and state databases as statutorily required for that applicants employment or affiliation with a licensee. dc9ae318d601feffffff00000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000ffffffffffffffffffffffff00000000000000000000000000000000000000000000000000000000 Live scan operator will sign and return a copy of the form to be uploaded into DACS by the screening agent. {\*\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 Sexual Violence Crisis Line 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. Medical Cannabis Production Establishment Agent Criminal Background Screening Authorization Form First Name: Last Name: I understand that my personal information including name, DOB, SSN and fingerprints will be used for the purpose of conducting a criminal history records search through any applicable state and federal databases. \par \tab \hich\af5\dbch\af31505\loch\f5 (b) does not include a critical access hospital, designated under 42 U.S.C. However, information must be submitted for children who have turned 12 and any adults who have moved into the home. . If you submit your forms via email, the Department will contact you to take payment over the phone. Any adults over the age of 18 residing in the home must complete a background screening. \fs24\lang1033\langfe1033\loch\f5\hich\af5\dbch\af31505\cgrid\langnp1033\langfenp1033 \sbasedon0 \snext0 toc 1;}{\s22\ql \li720\ri720\sl240\slmult0\nowidctlpar\tqr\tldot\tx9360\wrapdefault\hyphpar0\faauto\rin720\lin720\itap0 \rtlch\fcs1 Record Challenge Form Download. Sexual Violence Crisis Line Title: Microsoft Word - Policies and Procedures for Conducting Criminal Background Checks.docx \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. My personal information and fingerprints may be retained for ongoing monitoring and comparison against future submissions to the state, regional or federal database and latent fingerprint inquiries}. This includes citizens and noncitizens. \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; \snext11 \ssemihidden \sunhideused Normal Table;}{\s15\ql \li0\ri0\nowidctlpar\wrapdefault\faauto\rin0\lin0\itap0 \rtlch\fcs1 \af31507\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\loch\f5\hich\af5\dbch\af31505\cgrid\langnp1033\langfenp1033 \lsdpriority72 \lsdlocked0 Colorful List Accent 5;\lsdpriority73 \lsdlocked0 Colorful Grid Accent 5;\lsdpriority60 \lsdlocked0 Light Shading Accent 6;\lsdpriority61 \lsdlocked0 Light List Accent 6;\lsdpriority62 \lsdlocked0 Light Grid Accent 6; As a new employee of a DHS licensed agency or DHS contracted agency your background screening process will be fully automated in the Direct Access Clearance System (DACS). The applicant must also complete the Medical Cannabis Production Establishment Criminal Background Receipt form. b48cc799fc0d91f134462b381daafb4a492472d591f0564cc0a1911e76ea5678ba4e4ed9223becacd7d5c16656590592e5782d2cc6e1a04a66e856bb3cc02bd4 Depending on the nature of your application, supplemental authorities . 000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000ffffffffffffffffffffffff000000000000000000000000000000000000000000000000 ffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffff Sec. 534. 000000000000d60200007468656d652f7468656d652f7468656d65312e786d6c504b01022d00140006000800000021000dd1909fb60000001b01000027000000 \par \tab \hich\af5\dbch\af31505\loch\f5 (b) Religious groups; All Utahns should have fair and equitable opportunities to be healthy and safe. This action is part . footnote text;}{\*\cs19 \additive \rtlch\fcs1 \af5\afs20 \ltrch\fcs0 \f5\fs20 \sbasedon10 \slink18 \slocked \ssemihidden \styrsid14438297 Footnote Text Char;}{\*\cs20 \additive \rtlch\fcs1 \af0 \ltrch\fcs0 \super \sbasedon10 footnote reference;}{ \par \tab \hich\af5\dbch\af31505\loch\f5 (b) where an individual who is not a resident also lives. You may submit an Identity History Summary challenge to the FBI by writing to the following address: Attention: Criminal History Analysis Team1 1000 Custer Hollow Road, Headquarters Completely fill out the demographic section at the bottom of the form AND attach a copy of your ID and social security card. Apply for a license. Where to apply: Department of Public Safety Bureau of Criminal Identification 4315 South 2700 West Suite 1300 Taylorsville, Utah 84129 Phone: (801) 965-4445 Fax: (801) 969-7065 I need to obtain a copy of my Utah criminal history. c. UDOH is responsible for all fees associated with the criminal background checks for employees whose positions require background checks. Headquarters Multi-Agency State Office Building 195 North 1950 West Salt Lake City, Ut 84116. Several states maintain their own record system. \rtlch\fcs1 \af31507 \ltrch\fcs0 \insrsid7565795 \hich\af5\dbch\af31505\loch\f5 }{\rtlch\fcs1 \af5 \ltrch\fcs0 \insrsid7565795 ffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffff Utah Department of Health and Human Services is now one agency. \par \tab \hich\af5\dbch\af31505\loch\f5 (b) a small health care facility; Our vision is for Utah to be a place where all people can enjoy the best health possible, where all can live, grow, and prosper in healthy and safe communities. 4. \par \tab \hich\af5\dbch\af31505\loch\f5 (3) "Covered body" means a covered provid\hich\af5\dbch\af31505\loch\f5 er, covered contractor, or covered employer. Health, Administration. I also agree that a copy of this form is valid like the signed original. {\fdbminor\f31566\fbidi \froman\fcharset163\fprq2 Times New Roman (Vietnamese);}{\fhiminor\f31568\fbidi \fswiss\fcharset238\fprq2 Calibri CE;}{\fhiminor\f31569\fbidi \fswiss\fcharset204\fprq2 Calibri Cyr;} \lsdpriority50 \lsdlocked0 List Table 5 Dark Accent 2;\lsdpriority51 \lsdlocked0 List Table 6 Colorful Accent 2;\lsdpriority52 \lsdlocked0 List Table 7 Colorful Accent 2;\lsdpriority46 \lsdlocked0 List Table 1 Light Accent 3; 288 North 1460 West \par }{\rtlch\fcs1 \ab\af5 \ltrch\fcs0 \b\expnd0\expndtw-3\insrsid14438297 \hich\af5\dbch\af31505\loch\f5 R4\hich\af5\dbch\af31505\loch\f5 32-35-6. 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. \par \tab \hich\af5\dbch\af31505\loch\f5 (a) employment status; $33.25 submitted to DABS for each individual fingerprinted You may have live scan fingerprint services done at the DABS by appointment. faadb081f196af190c6a98242f8467912ab0a651ad6a5a548d8cc3c1aafb6121653923699635d3ca2aaa6abab39835c3b60cecd8f26645de60b53531e434b3c2 \rtlch\fcs1 \af31507 \ltrch\fcs0 \insrsid7565795 A potential IPs background check must be completed, and a fingerprint appointment scheduled (when applicable), before working with eligible Medicaid clients. ffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffff ;}{\levelnumbers\'01;}\rtlch\fcs1 \af0 \ltrch\fcs0 The following forms are for those authorized entities seeking to obtain criminal history information on employees or volunteers. \par \tab \hich\af5\dbch\af31505\loch\f5 (3) If the Department determines an individual is not eligible for direct patient access based upon the non-criminal background screening and the ind\hich\af5\dbch\af31505\loch\f5 Call: (801) 538-4242 PRIVACY POLICY ACKNOWLEDGEMENT FORM. \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 (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 (g) a home health agency; or {\fbiminor\f31585\fbidi \froman\fcharset186\fprq2 Times New Roman Baltic;}{\fbiminor\f31586\fbidi \froman\fcharset163\fprq2 Times New Roman (Vietnamese);}}{\colortbl;\red0\green0\blue0;\red0\green0\blue255;\red0\green255\blue255;\red0\green255\blue0; First Name Last Name. 1395tt; and \lsdpriority67 \lsdlocked0 Medium Grid 1 Accent 6;\lsdpriority68 \lsdlocked0 Medium Grid 2 Accent 6;\lsdpriority69 \lsdlocked0 Medium Grid 3 Accent 6;\lsdpriority70 \lsdlocked0 Dark List Accent 6;\lsdpriority71 \lsdlocked0 Colorful Shading Accent 6; \par }{\rtlch\fcs1 \ab\af5 \ltrch\fcs0 \b\expnd0\expndtw-3\insrsid14438297 \hich\af5\dbch\af31505\loch\f5 Authorizing, and Implemented or Interpreted Law: 26-21-9.5}{\rtlch\fcs1 \af5 \ltrch\fcs0 \expnd0\expndtw-3\insrsid14438297 Applicants also have the option to complete an online version of the Background Check Authorization form . {\fhiminor\f31574\fbidi \fswiss\fcharset178\fprq2 Calibri (Arabic);}{\fhiminor\f31575\fbidi \fswiss\fcharset186\fprq2 Calibri Baltic;}{\fhiminor\f31576\fbidi \fswiss\fcharset163\fprq2 Calibri (Vietnamese);} \par \tab \hich\af5\dbch\af31505\loch\f5 (vii) dietary and food service staff; Multi-Agency State Office Building \par \tab \hich\af5\dbch\af31505\loch\f5 (9) "Direct patient access" means for an individual to be in a position where \hich\af5\dbch\af31505\loch\f5 the individual could, in relation to a patient or resident of the covered body who engages the individual: {\flominor\f31555\fbidi \froman\fcharset186\fprq2 Times New Roman Baltic;}{\flominor\f31556\fbidi \froman\fcharset163\fprq2 Times New Roman (Vietnamese);}{\fdbminor\f31558\fbidi \froman\fcharset238\fprq2 Times New Roman CE;} \par \tab \hich\af5\dbch\af31505\loch\f5 (i) types and number; A face covering or mask is recommended for anyone being fingerprinted. \par \tab \hich\af5\dbch\af31505\loch\f5 (a) As required by Utah Code Subsection 26-21-204(4)(a)(ii)(E\hich\af5\dbch\af31505\loch\f5 ), juvenile court records shall be reviewed if an individual or covered individual is: \lsdpriority50 \lsdlocked0 List Table 5 Dark Accent 6;\lsdpriority51 \lsdlocked0 List Table 6 Colorful Accent 6;\lsdpriority52 \lsdlocked0 List Table 7 Colorful Accent 6;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Mention; BCI cannot provide criminal or court-ordered fingerprinting services. This form is for use by non-DHS licensed providers or adoption attorneys only, Complete a DCFS Livescan fingerprint scan and have the operator sign your Livescan Authorization form, Livescan locations and schedules may be accessed, Fingerprint cards may be submitted for applicants in rural areas who dont have access to Live Scan, There is no application fee for DCFS foster providers or adults living in the foster home. ffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffff OL staff will check site rosters for ongoing screening compliance. Fees for respite providers and one-time adoptions are outlined on the application form, The fee for Livescan at a DCFS office is $10. \par \tab \hich\af5\dbch\af31505\loch\f5 (b) a covered provider for services within the scope of the health facility license. \par \tab \hich\af5\dbch\af31505\loch\f5 (b) a long-term care hospital; These forms are only to be used by agencies who are authorized by statute, executive order, court rule, court order or local ordinance. 1-800-897-LINK(5465), You can find more information on background screenings in this, Abuse/Neglect of Seniors and Adults with Disabilities. \par \tab \hich\af5\dbch\af31505\loch\f5 (a) As required by Utah Code Subsection 26-21-204(3), the Department ma\hich\af5\dbch\af31505\loch\f5 If the individual is not eligible for cl 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. Principal Purpose: Certain determinations, such as employment, licensing, and security clearances, may be predicated on fingerprint-based background checks. \hich\af5\dbch\af31505\loch\f5 ety and health of patients or residents. \lsdsemihidden1 \lsdunhideused1 \lsdlocked0 HTML Top of Form;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 HTML Bottom of Form;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Normal (Web);\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 HTML Acronym; \par \tab \hich\af5\dbch\af31505\loch\f5 (2) "Clearance" means approval by the department under Section 26-21-203 for an individual to have direct patient access. (5) 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 the covered contractor and the i Your written request should clearly identify the information that you feel is inaccurate or incomplete and should include copies of any available proof or supporting documentation to support your claim. \par \tab \hich\af5\dbch\af31505\loch\f5 (ii) a disabled individual, as defined by department rule; The process for submitting these applications is as follows: Application: Fill out the application of the adoptive parent for the one-time clearance. \par \tab \hich\af5\dbch\af31505\loch\f5 (1) Utah Code, Title 26, Chapter 21, Part 2 requires that a covered contractor enter required information into the Di\hich\af5\dbch\af31505\loch\f5 }{\rtlch\fcs1 \af5 \ltrch\fcs0 \expnd0\expndtw-3\insrsid14438297 \lsdpriority48 \lsdlocked0 Grid Table 3 Accent 5;\lsdpriority49 \lsdlocked0 Grid Table 4 Accent 5;\lsdpriority50 \lsdlocked0 Grid Table 5 Dark Accent 5;\lsdpriority51 \lsdlocked0 Grid Table 6 Colorful Accent 5; 0528a2c6cce0239baa4c04ca5bbabac4df000000ffff0300504b01022d0014000600080000002100e9de0fbfff0000001c020000130000000000000000000000 Utah Domestic Violence 7ce8306e3b99fc70e5e3743265f3027d8d3af0c80e7af4b14f72f0d46749289dca0dc527421ffc08f83db398c0a092d3279eb838055cc5f0a8ca1c4c60e1228e Crisis Line & Mobile Outreach Team \lsdpriority63 \lsdlocked0 Medium Shading 1 Accent 6;\lsdpriority64 \lsdlocked0 Medium Shading 2 Accent 6;\lsdpriority65 \lsdlocked0 Medium List 1 Accent 6;\lsdpriority66 \lsdlocked0 Medium List 2 Accent 6; Health, Family Health and Preparedness, Licensing. \par \tab \hich\af5\dbch\af31505\loch\f5 (1) "Aged" means an individual who is 60 years of age or older. I understand that I may request to review any results of this inquiry and understand that UCA 53-10-108 does not allow the. \lsdqformat1 \lsdpriority34 \lsdlocked0 List Paragraph;\lsdqformat1 \lsdpriority29 \lsdlocked0 Quote;\lsdqformat1 \lsdpriority30 \lsdlocked0 Intense Quote;\lsdpriority66 \lsdlocked0 Medium List 2 Accent 1;\lsdpriority67 \lsdlocked0 Medium Grid 1 Accent 1; We have transtioned to DACS (Direct Access Clearance System), a completely online background screening system. This includes SAS & DSPD Certified Providers. 1-800-897-LINK(5465), Abuse/Neglect of Seniors and Adults with Disabilities. 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 (3) The covered provider must ensure that DACS reflects the current status of the covered individual within 5 working days of the engagement or termination. with health screenings and immunizations New look, new feelsame goals. . Screening applications typically take three weeks to process. inmate search by name utah county sheriff office afp police clearance kong form. How do I Renew my Concealed Firearm Permit? \lsdsemihidden1 \lsdunhideused1 \lsdlocked0 List Bullet 4;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 List Bullet 5;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 List Number 2;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 List Number 3; Screening Applications. \par \tab \hich\af5\dbch\af31505\loch\f5 (e) child abuse or neglect findings described in Section 78A-6-323; The FBI may retain your fingerprints and associated information/biometrics in NGI after the completion of this application and, while retained, your fingerprints may continue to be compared against other fingerprints submitted to or retained by NGI. }{\rtlch\fcs1 \af5 \ltrch\fcs0 \expnd0\expndtw-3\insrsid14438297 8376bf330efaaff23606569ea58fdc16605ecdebde7f010000ffff0300504b0304140006000800000021000dd1909fb60000001b010000270000007468656d65 Steps for Entering a Youth Application in DACS, Exemption Declaration (adult substance abuse treatment programs only), Contact Information for obtaining an out of state Central or Child Abuse Registry Check, I understand that my personal information including name, date of birth, social security number and fingerprints will be used for the purpose of conducting a criminal history records search through any applicable state and federal databases. The last 4 digits of your social security number, and; The date the application was submitted to the Office. \ltrch\fcs0 \fs24\lang1033\langfe1033\loch\f5\hich\af5\dbch\af31505\cgrid\langnp1033\langfenp1033 \sbasedon0 \snext0 toa heading;}{\s33\ql \li0\ri0\nowidctlpar\wrapdefault\faauto\rin0\lin0\itap0 \rtlch\fcs1 \af31507\afs24\alang1025 \ltrch\fcs0 Screening Minors (under age of 18) Prior to conducting criminal background screening on a minor (under age of 18), hiring departments must obtained a signed copy of the " Background Screening Consent Form for Minors " from the minor and the minor's parent or legal guardian. \par \tab \hich\af5\dbch\af31505\loch\f5 (a) an end stage renal disease facility; \hich\af5\dbch\af31505\loch\f5 individual notifying them of the right to appeal in accordance with R432-30. omni corporate code flyertalk, binance cancel pending withdrawal,