Individuals can submit a request under the Freedom of Information Act (FOIA) to the Michigan Department of Health and Human Services by clicking on the link below: Michigan's Freedom of Information Act (FOIA), https://dev.michigan.local/som/json?sc_device=json. CRC Form: Child Abuse Record Information Form Copy of CASA license SASE required 45 day New Mexico NM NEW MEXICO DOES NOT DO New York NY Office of Children & Family Services P.O. %%EOF The Michigan Department of Health and Human Services' (MDHHS) Division of Environmental Health (DEH) uses the best available science to reduce, eliminate, or prevent harm from environmental, chemical, and physical hazards. This authorization form is acceptable to the Michigan Department of Human Services as compliant with HIPAA privacy Individuals often contact the OCO with questions about confidential Childrens Protective Services (CPS) investigation of alleged child abuse or neglect. Information & resources for Community and Faith-Based partners. Please update to a modern browser such as Chrome, Firefox or Edge to experience all features Michigan.gov has to offer. Clearance requests are limited to certain employers, agencies, state officials, and individuals withappropriate authorization, signature, and identification. endstream endobj 86 0 obj <>/Metadata 31 0 R/Names 135 0 R/Outlines 191 0 R/PageLayout/OneColumn/PageMode/UseOutlines/Pages 83 0 R/StructTreeRoot 74 0 R/Type/Catalog/ViewerPreferences<>>> endobj 87 0 obj <. Health Care Coverage information and resources. l'dNC;#d`vX|-o{AAY `EfFD:`]o,n"}00$ `8N F a t h e r s n a m e F O R M T E X T F O R M T E X T F O R M T E X T F O R M T E X T F O R M T E X T 5 . Our office hours are 8 a.m. through 5 p.m. Monday through Friday. Box 4480 Albany, NY 12204-0480 TDD: (800) 638-5163 Toll- Free: (800) 342-3720 Phone: (518) 402-1653 Individuals must mail a signed letter to CFS Contact a Michigan Child Protective Services Defense Attorney Know Your Rights - Speak with an Experienced CPS Lawyer 1 (866) . You may be charged a reasonable cost-based fee. 6 endstream endobj startxref MDHHS News, Press Releases, Media toolkit, and Media Inquiries. If you are sending your request through the mail, please include a photocopy of your current driver's license showing the expiration date. For information about the CPS categories of abuse and neglect, read CPS and Your Family. Low-income Households Water Assistance Program (LIHWAP). The registry lists the following information: When your name is added to the Central Registry, you will get a letter from MDHHS telling you the following: Some CPS investigations lead to the filing of a court petition, which starts a child protection proceeding in court. You can also view the CPS Process Flow Chart to learn more about what could happen next in your case. The Michigan Domestic & Sexual Violence Prevention and Treatment Board administers state and federal funding for domestic violence shelters and advocacy services, develops and recommends policy, and develops and provides technical assistance and training. & W v " # H g wk hGQ hGQ \^J aJ hGQ \^J aJ hN~ hGQ 5\^J aJ hGQ hGQ OJ QJ ^J hGQ OJ QJ ^J hN~ hGQ OJ QJ ^J hGQ hGQ h1 hGQ 5\^J h- hGQ 5\^J h1 hGQ [ jxX;t203d12|fhfFo #?6?ll ,}f;7 [#u+{w022d0|bhbj+ Programs for healthy children & families, including immunization, lead poisoning prevention, prenatal smoking cessation, and many others. Following an investigation, States classify child abuse records in a variety of ways, depending on the State's statutory language. For trial court requests for central registry placement or removal in relation to a criminal conviction that occurred on or after November 1, 2022, complete the MDHHS-6023, Request for Central Registry Placement or Removal formand send the form, along with the Order of Conviction (Judgement of Sentence) or the Order Granting the Request for Removal, to [email protected]. S . Please specify below how you prefer to receive the records requested. records released to me or information relating to their contents, other than as provided by law. Contact Us Information about the Michigan law that requires certain information be made available to a woman who is seeking an abortion at least 24 hours prior to the abortion procedure. You may be asked to contact your direct care provider to access psychotherapy notes or other treatment information if your direct care provider created the original record. The individual is presumed to be a risk to children, and the burden is on the individual requesting to be removed from the central registry. Connect with Us 0 If you disagree with the MDHHS decision to list your name on the Central Registry, write a letter to the MDHHS director in the county where the investigation occurred. Information about the health care programs available through Medicaid and how to qualify. An adult who resides in a childs home. The purpose of the CPS investigation is to find out if your child was abused or neglected. Transcripts will be mailed. Michigan's Women, Infants & Children program, providing supplemental nutrition, breastfeeding information, and other resources for healthy mothers & babies. If you are requesting a birth certificate and the parents were not married at the time of the birth, and the child was born prior to 1978, the record must be obtained at the Michigan Department of Community Health. Please update to a modern browser such as Chrome, Firefox or Edge to experience all features Michigan.gov has to offer. Note: Recent amendments to the Child Protection Law. Information on resources in your community and volunteer recruitment and training, and services provided at local DHS offices. Checks or money orders must be made payable to: Cass County Clerk Register. Childrens Protective Services (CPS) cases that result in confirmed methamphetamineproduction, confirmed serious abuse or neglect, confirmed sexual abuse, or confirmed sexualexploitation will be classified as a central registry case in Michigan. Information about injury and violence prevention programs in Michigan. Records will be released if proper identification is provided. The records MDHHS maintains are limited to services provided by MDHHS programs. 2. Phone Number: This is not an exhaustive list and redactions may include more information: The identity of the person who complained to CPS about suspected child abuse or neglect. At The Kronzek Firm, we are experienced in representing clients who request removal from the CPS Central Registry. 0 m a i l . Approximately 34 States and the District of Columbia allow access to central registry records for agencies conducting background checks on individuals applying to be child care or youth care providers.16 Five States provide access to Tribal agencies to aid in determining the suitability of an individual to have access to children.17 Information We will continue to give updates as more information becomes available. Former students can submit a request for a transcript or other permanent student record in one of two ways: Records are mailed to your desired location via the US postal service. action. An individual who is the subject of a report or record made under the CPL may request the department amend or expunge an inaccurate report or record from the central registry and/or the case record within 180 calendar days from the date of service on the DHS-847a, Notice of Placement on Central Registry. Please contact the DCS Records Coordinator at 602-364-4319 or DCSRecordsRequest@azdcs . The form may also bemailed to or dropped off at: CPS Gatekeeper 925 Del Paso Blvd, Ste. State Requirements. Furthermore, they must notify you that it will be possible for certain people to access that information. Puerto Rico has no clear child abuse registry available. Include a fax number, if available, or a return mailing address. Bring a picture ID to verify your identity. Information describing an ongoing criminal investigation. CPS James Scenario 0614. If the abuse and neglect involved certain very serious harm, such as sexual abuse or serious physical injury, your name will stay on the Central Registry for your lifetime. Your name can go on this list even without a criminal conviction. 42 W. Madison StreetChicago, IL 60602773-553-1000, 2023 Chicago Public Schools | 1.0.8510 | M5, Close College and Career Planning (Grades 6-12) Subnav, Close Local School Councils (LSCs) Subnav, College and Career Planning (Grades 6-12), Family and Community Engagement (FACE) Managers, Proposed Policies or Rule Changes Open for Public Comment, Reporting Harassment, Misconduct, or Abuse. All Rights Reserved. CPS does not email or fax records. Please turn on JavaScript and try again. When making a transcript or records request, please consider the following projected timelines, allowing time for postal service delivery, to receive your records: If you are seeking a copy of your immunization records on file prior to 1989, you must submit your request directly to your former school. ! )@ fea The delay cannot be more than 30 calendar days. To learn more about child protection proceedings, read CPS and Your Family. Birth, Death, Marriage and Divorce Records. Desperation Without Dignity: Just One More Reason to Keep Families Together. Being listed on the Central Registry in Michigan prevents people from adopting a child, being a foster parent, licensing a daycare, working in a school, and more. If your request is denied, MDHHS will schedule an administrative hearing. S Please provide as much information as possible, including full names and dates of birth for the child, the parents and the alleged perpetrator (if a caregiver other than a parent). Bridge Card Participation Information on Electronic Benefits for clients and businesses, lists of participating retailers and ATMs, and QUEST. 1. Case Description: (required) U You must submit the form below with signature and a copy of your identification. You may request a review of the denial.Directions: Type or print all requested information with exception of signatures.Name of Facility or MDHHS program that maintains the individuals records FORMTEXT I n d i v i d u a l s n a m e ( b e n e f i c i a r y , r e c i p i e n t , p a t i e n t , c o n s u m e r , e t c . ) I n d i v i d u a l s I D n u m b e r ( M e d i c a i d , S S N , o t h e r ) F O R M T E X T F O R M T E X T S t r e e t a d d r e s s I n d i v i d u a l s d a t e o f b i r t h F O R M T E X T F O R M T E X T C i t y S t a t e Z I P c o d e P h o n e F O R M T E X T F O R M T E X T F O R M T E X T F O R M T E X T - F O R M T E X T - F O R M T E X T R e c o r d s r e q u e s t e d f o r a c c e s s ( I d e n t i f y t y p e a n d a m o u n t o f i n f o r m a t i o n , i n c l u d i n g d a t e s w h e r e a p p r o p r i a t e . Information on How to Bid, Requests for Proposals, forms and publications, contractor rates, and manuals. Adult Behavioral Health & Developmental Disability Services. Their phone number is 517-335-8666. Upon the departments review of aclearance request, the following will occur: For more information, or to submit a Central Registry Clearance Request, visit: Central Registry Clearance Requests (michigan.gov), Adult & Children's Services collapsed link, Safety & Injury Prevention collapsed link, Emergency Relief: Home, Utilities & Burial, Adult Behavioral Health & Developmental Disability, https://dev.michigan.local/som/json?sc_device=json, Behavioral and Physical Health and Aging Services Administration, Immunization Info for Families & Providers, Michigan Maternal Mortality Surveillance Program, Informed Consent for Abortion for Patients, Informed Consent for Abortion for Providers, Go to Child Welfare Medical and Behavioral Health Resources, Go to Children's Special Health Care Services, General Information For Families About CSHCS, Go to Emergency Relief: Home, Utilities & Burial, Supplemental Nutrition Assistance Program Education, Go to Low-income Households Water Assistance Program (LIHWAP), Go to Children's & Adult Protective Services, Go to Children's Trust Fund - Abuse Prevention, Bureau of Emergency Preparedness, EMS, and Systems of Care, Division of Emergency Preparedness & Response, Infant Safe Sleep for EMS Agencies and Fire Departments, Go to Adult Behavioral Health & Developmental Disability, Behavioral Health Information Sharing & Privacy, Integrated Treatment for Co-occurring Disorders, Cardiovascular Health, Nutrition & Physical Activity, Office of Equity and Minority Health (OEMH), Communicable Disease Information and Resources, Mother Infant Health & Equity Improvement Plan (MIHEIP), Michigan Perinatal Quality Collaborative (MI PQC), Mother Infant Health & Equity Collaborative (MIHEC) Meetings, Go to Birth, Death, Marriage and Divorce Records, Child Lead Exposure Elimination Commission, Coronavirus Task Force on Racial Disparities, Michigan Commission on Services to the Aging, Nursing Home Workforce Stabilization Council, Guy Thompson Parent Advisory Council (GTPAC), Strengthening Our Focus on Children & Families, Supports for Working with Youth Who Identify as LGBTQ, Go to Contractor and Subrecipient Resources, Civil Monetary Penalty (CMP) Grant Program, Nurse Aide Training and Testing Reimbursement Forms and Instructions, MI Kids Now Student Loan Repayment Program, Michigan Opioid Treatment Access Loan Repayment Program, MI Interagency Migrant Services Committee, Go to Protect MiFamily -Title IV-E Waiver, Students in Energy Efficiency-Related Field, Go to Community & Volunteer Opportunities, Go to Reports & Statistics - Health Services, Other Chronic Disease & Injury Control Data, Nondiscrimination Statement (No discriminacion), 2022-2024 Social Determinants of Health Strategy, Go to Reports & Statistics - Human Services, [email protected], Central Registry Clearance Requests (michigan.gov). Their phone number is 517-335-8666. Children's Protective Services (CPS) cases that result in confirmed methamphetamine production, confirmed serious abuse or neglect, confirmed sexual abuse, or confirmed sexual exploitation will be classified as a central registry case in Michigan. %%EOF Universal caseload, or task-based processing, is a different way of handling public assistance cases. If MDHHS denies the request, you may requestan administrative hearing. This means they remove your name and the evidence against you from the Central Registry, if they find that it is in the best interest of the child to do so. Once completed, the request form may be emailed (preferred method) as an attachment to [email protected] . This Court is for parents in Child Neglect and Abuse cases who have . Substance abuse treatment information. Child Welfare Medical and Behavioral Health Resources. CPS does not offer a walk-in records request service, and does not provide same-day or expedited document return services. Legislation policy and planning information. 500 Sacramento, Ca. The Michigan Department of Health and Human Services (MDHHS) Children's Services Agency (CSA) has requirements for requesting, reviewing and disseminating Criminal History Record Information (CHRI) obtained from the Law Enforcement Information Network (LEIN) system. You will receive an answer in writing. 2. Look into your state laws to learn the specifics on how you can request access to CPS records and the court case. For email: The requested records will be emailed to you via a secure link that requires login. Provider Payments Information on the direct deposit of State of Michigan payments into a provider's bank account. Maine - Before a child abuse history check can be requested, an agency must first register its agency with the State of Maine to receive such information. * 7% 7% 7% 7% 7% 3 3 1( 7% 7% 7% j4 7% 7% 7% 7% 89 7% 7% 7% 7% 7% 7% 7% 7% 7% > : ACCESS TO RECORDS REQUESTMichigan Department of Health and Human ServicesThis records request form concerns records maintained by Medicaid, other medical assistance programs, state facilities, and any other component of MDHHS that is subject to the HIPAA Privacy Regulations.Consider the following when requesting access to your records:You may ask to review and/or obtain information about yourself from records that the Michigan Department of Health and Human Services (MDHHS) maintains. - Manage notification subscriptions, save form progress and more. Please make sure to visit this page again should you need additional records in the future to ensure your request is submitted appropriately. The following is a list of people authorized to access the Central Registry: The identity of the person who reported the child abuse or neglect is kept confidential, unless that person consents to release of their name, or if the release has been ordered by a judge. You may also visit VitalCheck to order a birth, death or marriage record online. information about the Department's public safety programs. Information on DHS Applications and Forms grouped by category. How to Get a CPS Case Closed Prevention of diseases & conditions such as heart disease, cancer, diabetes and many others. Equal Opportunity, Legal Base, Laws and Reporting Welfare Fraud information. (1) Within 24 hours after receiving a report made under this act, the department must refer the report to the prosecuting attorney and the local law enforcement agency if the report meets the requirements of subsection (3) (a), (b), or (c) or section 3 (6) or (9) or must commence an investigation of the child suspected of being abused or neglected. Mail your application and money order to: Chicago Public SchoolsFormer Student Records - DACA3532 W. 47th PlaceChicago, IL. The Central Registry cannot be publicly searched. Student records may include both paper and electronic records. In addition, select criminalconvictions involving children will result in placement on central registry. Not more than once every 10 years after an individual has been listed on the central registry following a childrens protective services investigation, the individual may request a hearing regarding removal from the central registry. Request form submission does not guarantee nor entitle the submitter access to confidential case documents in part or entirety. Department of Child, Family and Adult Services, Become a Resources Family for Local Foster Children, In Home Supportive Services Application Process, Child Protective Services Relative Notification. Only records that are readily producible in electronic format will be sent electronically. Michigan Department of Health and Human Services (MDHHS), The names and birthdates of people who abused or neglected a child, The names and birthdates of children who were abused or neglected, The names of other adults or children who were in a home with an abused or neglected child but were not involved in the abuse or neglect, The type of abuse or neglect that happened, You have the right to review the case record, Who can view your name on the Central Registry, What to do if you disagree with your name being listed on the Central Registry. The registry lists the following information: The names and birthdates of people who abused or neglected a child If your name was placed on the Central Registry on or after March 31, 2015, you must make your written request within 180 days (six months) after you were notified that your name was placed on the Central Registry. If MDHHS denies the request, you may request an administrative hearing. Our office will accept cash, personal checks or money orders for payment. Within 30 days of classifying your alleged abuse as Category I or Category II, the Michigan Department of Health and Human Services (or. ) For more information about transcripts and other permanent student records, email Former Student Records at [email protected]. Box 8053 Harrisburg, PA 17105 Guam, Kentucky, Louisiana, Maine, Michigan, Ohio, Oregon, Rhode Island do not require a form. We will continue to give updates as more information becomes available. Once completed, the request form may be emailed (preferred method) as an attachment to [email protected]. People who are on the Central Registry because they have been accused of abuse or neglect have a right to see the record, but the name of the person who reported the abuse may be kept confidential. What to do if you believe the case record is inaccurate. The Central Registry is a document that is internal to the government and not available to the public. 8 D \ $ j4 t z >" T" T" T" /# ( W$ $ L q3 s3 s3 s3 s3 s3 s3 $ 5 8 3 7% /# /# 7% 7% 3 T" T" $4 ? A federal program which helps persons admitted into the U.S. as refugees to become self-sufficient after their arrival. If your request is made timely, an administrative hearing will be requested to determine by a preponderance ofthe evidence whether the report or record meets the statutory requirement for confirmed caseof methamphetamine production, confirmed serious abuse or neglect, confirmed sexual abuse,or confirmed sexual exploitation. Please leave this field empty. A person suspected of abusing or neglecting a child. 1. must notify you in writing that you are on the Central Registry. Getting Access to CPS Records. MDHHS will tell you the date, time, and location of the hearing. The type of information contained in central registries and department records varies from state to state, but usually includes the name of the alleged perpetrator(s). Licensing information for Adult Foster Care and Homes for the Aged, Child Day Care Facilities, Child Caring Institutions, Children's Foster Care Homes, Child Placing Agencies, Juvenile Court Operated Facilities and Children's or Adult Foster Care Camps. Date FORMTEXT 2 . Birth Certificates. Former Student Records - 1988 and Prior. * ? Information on assistance with home repairs, heat and utility bills, relocation, home ownership, burials, home energy, and eligibility requirements. CPS can provide former students with a copy of a high school transcript, verification of a graduation date from high school, a copy of an elementary school transcript, and an elementary registration card or immunization records. If the Michigan Department of Human Services (or CPS) refuses your request for amendment or expungement, or fails to act within 30 days of your request, they must hold an administrative hearing regarding the proposed amendment or expungement. U & _ . _ T V _ v V + , r 6 - \ m- + + + QX QX 2 + + + TY - - - - _ + + + + + + + + + : REPORT OF ACTUAL OR SUSPECTED CHILD ABUSE OR NEGLECTMichigan Department of Human ServicesWas complaint phoned to DHS? FORMCHECKBOX Email FORMCHECKBOX Fax FORMCHECKBOX U.S. MailSend records to (specify individual if different from individual whose records are being requested) FORMTEXT S t r e e t a d d r e s s F O R M T E X T C i t y S t a t e Z I P c o d e F O R M T E X T F O R M T E X T F O R M T E X T E m a i l F a x n u m b e r F O R M T E X T F O R M T E X T L e g a l r e p r e s e n t a t i v e s n a m e L e g a l r e p r e s e n t a t i v e s r e l a t i o n s h i p t o i n d i v i d u a l ( A l e t t e r o f a u t h o r i t y m a y b e r e q u e s t e d ) F O R M T E X T F O R M T E X T S i g n a t u r e o f I n d i v i d u a l o r l e g a l r e p r e s e n t a t i v e D a t e F O R M T E X T Y o u h a v e t h e f o l l o w i n g r i g h t s t o a c c e s s y o u r i n f o r m a t i o n : Y o u h a v e a r i g h t t o h a v e a n a n s wer to your request within 30 calendar days. Records Management Section 275 E. Main St., 3E-G Frankfort, KY 40621. The Michigan Department of Health and Human Services (MDHHS) keeps this list. The State of Michigan keeps a list of people who have abused or neglected children in the state. Know Your Rights Speak with an Experienced CPS Lawyer G/s H3200 v3;[{ZzJ+:K23kkrs you may request the Michigan Department of Human Services amend an inaccurate CPS report or record.

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. Information on Adult Protective Services, Independent Living Services, Adult Community Placement Services, and HIV/AIDS Support Services. Information on adoption programs, adoption resources, locating birth parents and obtaining information from adoption records. * V 1 @ 2 T" 6 % F 2 ]3 :4 0 j4 2 x 89 % b 89 2 89 2 7% 7% ?
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cps records request form michigan 2023