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Families & Children Women Teens Adults Seniors People with Disabilities
For all individuals requiring a background check who have lived in other states during any part of the last five years there must be an abuse and neglect registry check completed in each of those states. Please review the instructions on the chart and print and complete the form required by each state and return it to the Child Care Licensing Unit (unless otherwise indicated). Please call our office with any questions in order to ensure this process is completed as quickly as possible as it could impact your ability to work in a child care program.

Submit the completed state request, payment (if applicable), and New Hampshire Household and Personnel Form Adobe Acrobat Reader Symbol to:

Child Care Licensing
129 Pleasant Street
Concord, NH 03301

ALL forms should be submitted to CCLU. Results sent to CCLU from the individual will NOT be accepted. Please call with questions to ensure forms are completed properly and results are more timely.

NOTE: If an individual has current fingerprint results and your program is submitting an H&P ONLY please ask CCLU or the individual if they have already had out of state checks completed for previous residences. IF they have there is no need to resubmit the out of state forms.

States & Territories
(link to form)
Instructions
Alabama Adobe Acrobat Reader Symbol Complete Requestor Information and remainder of form and submit.
Alaska Adobe Acrobat Reader Symbol Complete state form and submit.
Arizona Adobe Acrobat Reader Symbol Complete state form and submit.
Arkansas Adobe Acrobat Reader Symbol
  1. Complete, sign and notarize the state form; and
  2. submit with a check for $10.00 made out to: Department of Human Services.
California (n/a) California is a closed state. The Department of Justice does not process inquiries for Employment or Volunteer purposes. Dissemination of CACI information is restricted and controlled by the Penal Code.
Colorado

Colorado Revised Statute (CRS) 19-1-307 does not allow the CDHS OEC Background Investigations Unit to process requests for applicants working in a child care program that is NOT licensed by CDHS.

Connecticut Adobe Acrobat Reader Symbol Complete state form and submit.
Delaware Adobe Acrobat Reader Symbol Complete state form and submit.
Florida Adobe Acrobat Reader Symbol Complete state form and submit.
Georgia Adobe Acrobat Reader Symbol Complete state form and submit.
Hawaii Adobe Acrobat Reader Symbol Complete state form and submit.
Idaho Adobe Acrobat Reader Symbol
  1. Complete, sign, and notarize the state form; and
  2. Submit with a check for $20.00 made out to: Idaho Department of Health and Welfare
Illinois Adobe Acrobat Reader Symbol Complete state form and submit.
Indiana Adobe Acrobat Reader Symbol Complete state form and submit.
Iowa Adobe Acrobat Reader Symbol Complete state form, sign in Section 2, and submit.
Kansas Adobe Acrobat Reader Symbol
  1. Complete and sign the state form; and
  2. Submit with a check for $10.00 made out to: Kansas Department of Children & Families
Kentucky Adobe Acrobat Reader Symbol
  1. Complete and sign the state form; and
  2. Submit with a check for $10.00 made out to: Kentucky State Treasurer
Louisiana (n/a)  
Maine Adobe Acrobat Reader Symbol
  1. Complete and sign the state form; and
  2. submit with a check for $15.00 made out to: Treasurer: State of Maine
    DO NOT SUBMIT for individuals UNDER 18 (Maine ONLY)
Maryland Adobe Acrobat Reader Symbol Complete state form and submit.
Massachusetts Adobe Acrobat Reader Symbol Complete state form and submit.
Michigan Adobe Acrobat Reader Symbol Complete Section 1 of the state form, attach a clear copy of a photo ID, and submit.
Minnesota Adobe Acrobat Reader Symbol
  1. Complete, sign, and notarize the state form; and
  2. Submit with a check for $20.00 made out to: Minnesota Department of Human Services
Mississippi Adobe Acrobat Reader Symbol Complete state form and submit.
Missouri Adobe Acrobat Reader Symbol Complete state form and submit.
Montana Adobe Acrobat Reader Symbol Complete state form and submit.
Nebraska Adobe Acrobat Reader Symbol Complete the state form, sign at * on page two, notarize Section A, and submit. If under 19 years of age a legal guardian must sign above Section C.
Nevada Adobe Acrobat Reader Symbol Complete state form, enclose a copy of an ID card, driver's license or other identification, and submit.
New Jersey Adobe Acrobat Reader Symbol Complete state form and submit.
New Mexico Adobe Acrobat Reader Symbol Complete state form and submit.
New York Adobe Acrobat Reader Symbol Complete, sign, and notarize the state form, and submit.
North Carolina Adobe Acrobat Reader Symbol Complete state form and submit.
North Dakota Adobe Acrobat Reader Symbol
  1. Initial two areas in Part II of form; and
  2. 2. Complete remainder of state form, sign, and submit.
Ohio Adobe Acrobat Reader Symbol Complete PAGE 1 ONLY of state form and submit.
Oklahoma (n/a) No forms required.
Oregon Adobe Acrobat Reader Symbol Complete state form and submit.

Pennsylvania Adobe Acrobat Reader Symbol

Consent/Release
of Information
Authorization
Adobe Acrobat Reader Symbol

  1. Complete and sign the state form from the "Applicant Demographic" section and below (2 sides);
  2. Complete the Consent/Release of Information Authorization Form (2 sides); and
  3. Submit both forms with a check for $8.00 made out to: Pennsylvania Department of Human Services.
Rhode Island Adobe Acrobat Reader Symbol Complete state form and submit.
South Carolina Adobe Acrobat Reader Symbol
  1. Complete and sign the state form; and
  2. Submit completed form with a check for $8.00 made out to: South Caroline Department of Social Services.
South Dakota Adobe Acrobat Reader Symbol Complete state form and submit.
Tennessee Adobe Acrobat Reader Symbol Complete state form and submit.
Texas Adobe Acrobat Reader Symbol Complete sections 3 & 6, notarize and submit state form.
Utah Adobe Acrobat Reader Symbol

Complete the state form and return with a legible and valid copy of one of the following:

  1. Driver's License; or
  2. State Issued ID; or
  3. Passport.
Vermont Adobe Acrobat Reader Symbol Complete state form and submit.
Virginia Adobe Acrobat Reader Symbol
  • Complete, sign & notarize the state form; and
  • submit with a $10.00 MONEY ORDER ONLY Made out to: Virginia Department of Social Services
Washington Adobe Acrobat Reader Symbol
  1. Complete and sign the state form; and
  2. Submit with a check for $20.00 made out to: DSHS Children's Admin
Washington D.C. Adobe Acrobat Reader Symbol Complete form, sign in BLUE ink, and return.
West Virginia Adobe Acrobat Reader Symbol Complete form, sign in BLUE ink, and return.
Wisconsin Adobe Acrobat Reader Symbol Complete form, have signature witnessed, and return.
Wyoming Adobe Acrobat Reader Symbol
  1. Complete and sign the state form; and
  2. Submit with a check for $10.00 Check or Money Order made out to: State of Wyoming
Puerto Rico Adobe Acrobat Reader Symbol Complete the Puerto Rico form and submit.
Virgin Islands (n/a) No abuse and neglect registry.

Adobe Acrobat Reader Symbol Adobe Acrobat Reader format. You can download a free reader from Adobe.

 
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New Hampshire Department of Health and Human Services
129 Pleasant Street | Concord, NH | 03301-3852


copyright 2016. State of New Hampshire