02000000180000004d73786d6c322e534158584d4c5265616465722e362e3000000000000000000000060000 However, if your application has been submitted for longer than three weeks, you can request a status update by emailing cbsunit@utah.gov. OL Rule R501-14 outlines how OL makes employment determinations. Record Challenge Form Download. \par 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. In the event that there is incorrect or missing Utah Criminal Data, please be prepared to provide certified copies from any arresting agency or court of appearance. Covered Provider - Direct Access Clearance System Process. You may be eligible to request a conditional clearance per R501-14-7-2if: The following information is required in order to request a conditional approval: If you meet the above criteria, you may request a conditional approval here. Child Abuse/Neglect voluntary, by what statutory or other authority your SSAN is solicited, and what uses will be made of it. {\*\colorschememapping 3c3f786d6c2076657273696f6e3d22312e302220656e636f64696e673d225554462d3822207374616e64616c6f6e653d22796573223f3e0d0a3c613a636c724d 7afeb3d9a4d2f13d2151ba4094a5b8e76fb0f03fbbf7eb5fdd454732c609f6403e1547a8e7c752ae8eaa5531876124eeb0154ee1bb25e30992f0caa3ea82a34b \par }}{\*\ftnsepc \ltrpar \pard\plain \ltrpar\ql \li0\ri0\nowidctlpar\wrapdefault\faauto\rin0\lin0\itap0\pararsid14438297 \rtlch\fcs1 \af5\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\loch\af5\hich\af5\dbch\af31505\cgrid\langnp1033\langfenp1033 { Multi-Agency State Office Building fa1e4542c2173dbfa6fffceabdbb5574940b517940d6909be8bf5c2e17589c37f49c3c3a2b260d823068f50bfd1a40e53e6edc1eb7c6ad429f06a0f91c569a71 \par \tab \hich\af5\dbch\af31505\loch\f5 (iii) any felony or class A, B or C conviction under the following Utah Codes: $33.25 submitted to DABS for each individual fingerprinted You may have live scan fingerprint services done at the DABS by appointment. \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. Your SSAN is needed to keep records accurate because other people may have the same name and birth date. You may submit the background check forms one of three ways: Bring them into the Utah Department of Agriculture and Food in person, submit by U.S. Mail, or by Utah Domestic Violence As of July 1, 2015 BCI will begin to qualify private entities to submit fingerprint based background checks to the FBI and provide them with FBI criminal information. Depending on the nature of your application, supplemental authorities include Federal statutes, State statutes pursuant to Pub. \par \tab \hich\af5\dbch\af31505\loch\f5 (iv) a provider of medical, therapeutic, or social services, including a provider of laboratory and radiology\hich\af5\dbch\af31505\loch\f5 services; Screening agent will submit payment for the online application processing. \par \tab \hich\af5\dbch\af31505\loch\f5 (1) if significant problems exist that are likely to lead to the harm of an individual resident, the department may impose a \hich\af5\dbch\af31505\loch\f5 civil penalty of $50 to $1,000 per day; and \lsdpriority68 \lsdlocked0 Medium Grid 2 Accent 1;\lsdpriority69 \lsdlocked0 Medium Grid 3 Accent 1;\lsdpriority70 \lsdlocked0 Dark List Accent 1;\lsdpriority71 \lsdlocked0 Colorful Shading Accent 1;\lsdpriority72 \lsdlocked0 Colorful List Accent 1; \par \tab \hich\af5\dbch\af31505\loch\f5 (2) If th\hich\af5\dbch\af31505\loch\f5 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. Department of Human Services, Office of Licensing to provide a copy of those results to me. \par \tab \hich\af5\dbch\af31505\loch\f5 (4) "Corporation" means a corporation that has business interest/connection to covered providers that employ individuals who provide consultative services which may result in direct patient access. \par \tab \hich\af5\dbch\af31505\loch\f5 (b) juvenile court arrest, adjudication, and disposition records, as allowed under Section 78A-6-209; \par }{\rtlch\fcs1 \ab\af5 \ltrch\fcs0 \b\expnd0\expndtw-3\insrsid14438297 \hich\af5\dbch\af31505\loch\f5 R432-35-5. \par \tab \hich\af5\dbch\af31505\loch\f5 (ii) child abuse or neglect findings described in Section 78A-6-323; 1-800-897-LINK(5465). 1-800-273-TALK(8255) ss Clearance System to run a verification report and verify that each covered individual's information is correct, including: \par \tab \hich\af5\dbch\af31505\loch\f5 (g) registries of nurse aids described in Title 42 Code of Federal Regulations Section 483.156; \par \tab \hich\af5\dbch\af31505\loch\f5 (viii) housekeeping; {\revtim\yr2020\mo4\dy22\hr14\min21}{\version2}{\edmins0}{\nofpages1}{\nofwords2655}{\nofchars15139}{\nofcharsws17759}{\vern125}}{\*\xmlnstbl {\xmlns1 http://schemas.microsoft.com/office/word/2003/wordml}} 416e376a6168b9ed2bb5a5f5adb979b1cdce5e40f2184197bba6526857c2c92e47d0104d754f92a50dd8222f65be35e0c95b73d2f3bfac85fd60d80887955a27 {\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;} I need to obtain a copy of my nationwide criminal history from the FBI. \par \tab \hich\af5\dbch\af31505\loch\f5 (3) The covered contractor must ensure the \hich\af5\dbch\af31505\loch\f5 Direct Access Clearance System reflects the current status of the covered individual within 5 working days of placement or termination. Employee Background Screening. \par \tab \hich\af5\dbch\af31505\loch\f5 (i) a nursing assistant; overed provider must submit required information to the Department to initiate and obtain a clearance prior to the issuance of the provisional license. Until the Office of Licensing has approved the screening, an applicant shall have no direct access to a child of vulnerable adult. Each agency is responsible to identify a minimum of two Background Screening Agents to be responsible for training and completing all of the agencys background screening applications in DACS, payments, and all communications with OL regarding background screenings. \par \tab \hich\af5\dbch\af31505\loch\f5 (b) which may include: I understand that my personal information including name, DOB, SSN and fingerprints will be used for the purpose of . Pursuant to the Federal Privacy Act of 1974 (5 USC 552a), the requesting agency is responsible for informing you whether disclosure is mandatory or. \paperw12240\paperh15840\margl1440\margr1440\margt1440\margb1440\gutter0\ltrsect Purpose. \par \tab \hich\af5\dbch\af31505\loch\f5 The department may impose civil monetary penalties in accordance with Title 26, Chapter 23, Utah Health Code Enforcement Provisions and Penalties, if th\hich\af5\dbch\af31505\loch\f5 \par \tab \hich\af5\dbch\af31505\loch\f5 (h) a personal care agency. Health, Administration. {\f877\fbidi \froman\fcharset163\fprq2 Cambria Math (Vietnamese);}{\flomajor\f31508\fbidi \froman\fcharset238\fprq2 Times New Roman CE;}{\flomajor\f31509\fbidi \froman\fcharset204\fprq2 Times New Roman Cyr;} 1-801-587-3000 \par \tab \hich\af5\dbch\af31505\loch\f5 To outline the process required for individuals to be cleared to have direct patient access while employed by a covered provider, covered contractor or covered employer. SUBJECT: Memorandum Report: State Requirements for Conducting Background Checks on Hom e Health Agency Employees, OEI-07-14-00131 In response to a congressional request, the Office oflnspector General (OIG) initiated two . dhslicensing@utah.gov. Utah Administrative Code; Topic - Health; Title R432 - Family Health and Preparedness, Licensing; . Criminal Background Screening Published: Nov 30, 2022 Responsible Unit: Vice President for Human Resources 1. 1-800-371-7897 OL staff will check site rosters for ongoing screening compliance. Utah Domestic Violence Live scan operator will sign and return a copy of the form to be uploaded into DACS by the screening agent. (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 4. \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; RULE ANALYSIS Purpose of the rule or reason for the change: The purpose of this amendment is to modify this rule to allow fingerprinting of applicants under the age of 18, clarify the types of deniable charges and convictions, and to make technical changes that match the current process for background screening for licensed health . 2f7468656d652f5f72656c732f7468656d654d616e616765722e786d6c2e72656c73848f4d0ac2301484f78277086f6fd3ba109126dd88d0add40384e4350d36 Forms. \par }{\rtlch\fcs1 \ab\af5 \ltrch\fcs0 \b\expnd0\expndtw-3\insrsid14438297 \hich\af5\dbch\af31505\loch\f5 KEY: health care facilities, background screening}{\rtlch\fcs1 \af5 \ltrch\fcs0 \expnd0\expndtw-3\insrsid14438297 {\fhiminor\f31571\fbidi \fswiss\fcharset161\fprq2 Calibri Greek;}{\fhiminor\f31572\fbidi \fswiss\fcharset162\fprq2 Calibri Tur;}{\fhiminor\f31573\fbidi \fswiss\fcharset177\fprq2 Calibri (Hebrew);} \lsdpriority52 \lsdlocked0 List Table 7 Colorful Accent 4;\lsdpriority46 \lsdlocked0 List Table 1 Light Accent 5;\lsdpriority47 \lsdlocked0 List Table 2 Accent 5;\lsdpriority48 \lsdlocked0 List Table 3 Accent 5; ffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffff \par \tab \hich\af5\dbch\af31505\loch\f5 (i) the type of offense; \lsdpriority46 \lsdlocked0 List Table 1 Light Accent 2;\lsdpriority47 \lsdlocked0 List Table 2 Accent 2;\lsdpriority48 \lsdlocked0 List Table 3 Accent 2;\lsdpriority49 \lsdlocked0 List Table 4 Accent 2; Authority. \hich\af5\dbch\af31505\loch\f5 \hich\af5\dbch\af31505\loch\f5 record, the individual may challenge the information as provided in Utah Code Annotated Sections 77-18a. 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. s, based on information obtained through the Direct Access Clearance System, the Department shall send a Notice of Agency Action to the covered provider and the individual explaining the action and the individual's right of appeal as defined in R432-30. \par \tab \hich\af5\dbch\af31505\loch\f5 (c)\hich\af5\dbch\af31505\loch\f5 a nursing care facility; \par \tab \hich\af5\dbch\af31505\loch\f5 (C) 76-9-301.8, Bestiality; \par : 43144 Filed: 08/10/2018 09:20:21 AM. \par \tab \hich\af5\dbch\af31505\loch\f5 (5) If the Department determines an individual is not eligible for direct patient acces\hich\af5\dbch\af31505\loch\f5 \par \tab \hich\af5\dbch\af31505\loch\f5 (15) "Resident" means an individual who receives health care services from one of the following\hich\af5\dbch\af31505\loch\f5 covered providers: This information will be used by the Department of Human Services, Office of Licensing to determine my eligibility to have direct access to a child or vulnerable adult. ffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffff \par }{\rtlch\fcs1 \ab\af5 \ltrch\fcs0 \b\expnd0\expndtw-3\insrsid14438297 \hich\af5\dbch\af31505\loch\f5 R432-35-2. Choose which box in the top left applies to you: If you are a new applicant with Utah Foster Care, mark the first box, If you are already licensed as a DCFS Foster Parent, or are residing in an Office of Licensing licensed foster home, mark the second box and include the licensor name, If you are working with an agency other that Utah Foster Care or DCFS, mark the third box and include the name of the agency, Legibly complete sections 1-5, filling in every box. Cannon Health Building 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. Use Form I-9 to verify the identity and employment authorization of individuals hired for employment in the United States. \par \tab \hich\af5\dbch\af31505\loch\f5 (b) Adjudications by a juvenile court may\hich\af5\dbch\af31505\loch\f5 A face covering or mask is recommended for anyone being fingerprinted. (2) 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 t\hich\af5\dbch\af31505\loch\f5 Division in the Department of Justice (DOJ) collects the information requested on this form as authorized by Business and Professions Code sections 4600-4621, 7574-7574.16, 26050-26059, 11340-11346, and 22440-22449; Penal Code sections 11100-11112, and 11077.1; Health and Safety Code sections 1522, DACS Information Worksheet (for use by foster parents and other adults living in foster homes), Background Screening Application DCFS Foster/Kinship Respite Providers only, Background Screening Application Youth Transport Company employeees only, Background Screening Application Adoption (One-time adoption application no RapBack or Adam Walsh clearance). 6e22206267313d226c743122207478313d22646b3122206267323d226c743222207478323d22646b322220616363656e74313d22616363656e74312220616363 {\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;} MVR screening requires an additional consent form. corresponding number and place in the Caregivers Criminal History Screening Program Authorization For Release of Information. {\*\pnseclvl7\pnlcrm\pnstart1\pnindent720\pnhang {\pntxtb (}{\pntxta )}}{\*\pnseclvl8\pnlcltr\pnstart1\pnindent720\pnhang {\pntxtb (}{\pntxta )}}{\*\pnseclvl9\pnlcrm\pnstart1\pnindent720\pnhang {\pntxtb (}{\pntxta )}}\pard\plain \ltrpar One-time Adoption Screening. Processing includes making a determination of . 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. The screening or background check includes the submission of fingerprints for clearance on the federal data system. Sexual Violence Crisis Line b175b61bc320c71aa0ecd1a17bd41e35eb16ded0dfdce3dc0fd5c7c26b50a63fd8c34f2643b0a285d7a00c1feee1c3417730b2f56b50866fede1dbb5fe28685b a1a82fe353bd90a865aad41ed0b5b8f9d6fd010000ffff0300504b0304140006000800000021006b799616830000008a0000001c0000007468656d652f746865 1-800-371-7897 \par \tab \hich\af5\dbch\af31505\loch\f5 (a) a nursing care facility; Applicant must provide all known substantiated findings of abuse, neglect or exploitation or any felony criminal history to the department upon submission of the criminal history screening application. \rtlch\fcs1 \af31507 \ltrch\fcs0 \insrsid7565795 \hich\af5\dbch\af31505\loch\f5 }{\rtlch\fcs1 \af5 \ltrch\fcs0 \insrsid7565795 To schedule an appointment, please click here. and a set of fingerprints to the FBI to match against criminal background information maintained . 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}. 1-855-323-DCFS(3237) With the required release and proper payment, all adult arrest records are released. \par }{\rtlch\fcs1 \ab\af5 \ltrch\fcs0 \b\expnd0\expndtw-3\insrsid14438297 \hich\af5\dbch\af31505\loch\f5 R432-35-1. The process for SD state only criminal background checks includes submitting a fingerprint card, the Authorization form, and payment for each fingerprint card submitted. Crisis Line & Mobile Outreach Team \lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Date;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Body Text First Indent;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Body Text First Indent 2;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Note Heading; For information on obtaining the Out of State Registry, visit this link on our website: https://dlbc.utah.gov/out-of-state-registries, Submit the fee of $37.25 per application in one of the following forms: Company check, cashiers check, or money order made payable to Department of Human Services. \lsdsemihidden1 \lsdunhideused1 \lsdlocked0 List Continue 5;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Message Header;\lsdqformat1 \lsdpriority11 \lsdlocked0 Subtitle;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Salutation; Applicants also have the option to complete an online version of the Background Check Authorization form . Email: dhslicensing@utah.gov, HotlinesAbuse/Neglect of Seniors and Adults with Disabilities \lsdpriority47 \lsdlocked0 List Table 2 Accent 3;\lsdpriority48 \lsdlocked0 List Table 3 Accent 3;\lsdpriority49 \lsdlocked0 List Table 4 Accent 3;\lsdpriority50 \lsdlocked0 List Table 5 Dark Accent 3; earance for a covered individual. A student employee moves to a non-student position. \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; If you believe a background check has been triggered for some other than the reasons listed above, contact HR Records at hrsc-records@austin.utexas.edu or 512-471-4772. \ltrch\fcs0 \hres0\chhres0 }{\listlevel\levelnfc4\levelnfcn4\leveljc0\leveljcn0\levelfollow2\levelstartat1\levelspace0\levelindent0{\leveltext\'02\'07);}{\levelnumbers\'01;}\rtlch\fcs1 \af0 \ltrch\fcs0 \hres0\chhres0 }{\listlevel\levelnfc255\levelnfcn255 }}{\*\pnseclvl2\pnucltr\pnstart1\pnindent720\pnhang {\pntxta . \par The DSS will pay any fees required. \lsdpriority49 \lsdlocked0 Grid Table 4 Accent 6;\lsdpriority50 \lsdlocked0 Grid Table 5 Dark Accent 6;\lsdpriority51 \lsdlocked0 Grid Table 6 Colorful Accent 6;\lsdpriority52 \lsdlocked0 Grid Table 7 Colorful Accent 6;