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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.

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

Child Care Licensing
129 Pleasant Street
Concord, NH 03301

ALL forms should be returned to CCLU unless otherwise indicated. Results sent to CCLU from the individual will NOT be accepted. ONLY Ohio results should be handled by the individual. Please call with questions to ensure forms are completed properly and results are more timely.

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 and submit state form.
Arizona Adobe Acrobat Reader Symbol Complete and submit state form.
Arkansas Adobe Acrobat Reader Symbol
  1. Complete the state form;
  2. Sign and notarize; and
  3. Submit 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 Adobe Acrobat Reader Symbol
  1. Complete state form;
  2. Sign at both areas indicated with a checkmark; and
  3. Submit completed form with a check for $28.00 made out to: CDHS, BIU, and Records & Reports.
Connecticut Adobe Acrobat Reader Symbol Complete and submit state form.
Delaware Adobe Acrobat Reader Symbol Complete and submit state form.
Florida Adobe Acrobat Reader Symbol Complete and submit state form.
Georgia Adobe Acrobat Reader Symbol Complete and submit state form.
Hawaii Adobe Acrobat Reader Symbol Complete and submit state form.
Idaho Adobe Acrobat Reader Symbol
  1. Complete and sign the enclosed form;
  2. Notarize the form; and
  3. Submit completed form with a check for $20.00 made out to: Idaho Department of Health and Welfare.
Illinois Adobe Acrobat Reader Symbol Complete and submit state form.
Indiana Adobe Acrobat Reader Symbol Complete and submit state form.
Iowa Adobe Acrobat Reader Symbol Complete and submit state form.
Kansas Adobe Acrobat Reader Symbol
  1. Complete and sign the enclosed form; and
  2. Submit completed form with a check for $10.00 made out to: Kansas Department of Children & Families.
Kentucky Adobe Acrobat Reader Symbol
  1. Complete and sign the enclosed form; and
  2. Submit completed form with a check for $10.00 made out to: Kentucky State Treasurer.
Louisiana (n/a) Abuse and neglect checks not allowed for employment until July 1, 2018.
Maine Adobe Acrobat Reader Symbol
  1. Complete the state form;
  2. Sign; and
  3. Submit completed form with a check for $15.00 made out to: Treasurer: State of Maine.
Maryland Adobe Acrobat Reader Symbol Complete and submit state form. MUST BE TYPED.
Massachusetts Adobe Acrobat Reader Symbol Complete and submit state form.
Michigan Adobe Acrobat Reader Symbol Complete Section 1 of form, attach a clear copy of a photo ID, and submit.
Minnesota Adobe Acrobat Reader Symbol
  1. Complete and sign & notarize the enclosed form; and
  2. Submit completed form with a check for $20.00 made out to: Minnesota Department of Human Services.
Mississippi Adobe Acrobat Reader Symbol Complete and submit state form.
Missouri Adobe Acrobat Reader Symbol Complete and submit state form.
Montana Adobe Acrobat Reader Symbol Complete and submit state form.
Nebraska Adobe Acrobat Reader Symbol Complete and submit form.
Sign at * on page two and notarize Section A. If under 19 years of age a legal guardian must sign above Section C and sign above.
Nevada Adobe Acrobat Reader Symbol Complete and submit form, enclose a copy of an ID card, driver's license or other identification.
New Jersey Adobe Acrobat Reader Symbol Complete and submit state form.
New Mexico Adobe Acrobat Reader Symbol Complete and submit state form.
New York Adobe Acrobat Reader Symbol Complete, notarize, and submit state form.
North Carolina Adobe Acrobat Reader Symbol Complete and submit state form.
North Dakota Adobe Acrobat Reader Symbol
  1. Initial two areas in Part II of form; and
  2. Complete, sign, and return state form.
Ohio Adobe Acrobat Reader Symbol Complete form and submit DIRECTLY TO OHIO, once the individual receives results they should be sent to CCLU.
Oklahoma (n/a) No forms required.
Oregon Adobe Acrobat Reader Symbol Complete and submit state form.

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 and submit state form.
South Carolina Adobe Acrobat Reader Symbol
  1. Complete and sign the enclosed 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 and submit state form.
Tennessee Adobe Acrobat Reader Symbol Complete and submit state form.
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
  2. State Issued ID
  3. Passport
Vermont Adobe Acrobat Reader Symbol Complete and submit state form.
Virginia Adobe Acrobat Reader Symbol Complete, sign, notarize and return form.
$10 MONEY ORDER ONLY Made out to:
Virginia Department of Social Services
Washington Adobe Acrobat Reader Symbol Complete state form. MUST BE TYPED.
$20 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 Complete state form,
$10 Check or Money Order made out to:
State of Wyoming
Puerto Rico Adobe Acrobat Reader Symbol Complete the Puerto Rico form and return.
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