utah department of health criminal background screening authorization form

The top portion needs to be signed by the applicant, the bottom portion is signed by the non-licensed entity. PDF Home Caregiver Consent & Authorization Background Check Verification Routine uses include, but are not limited to, disclosures to: employing, governmental or authorized non-governmental agencies responsible for employment, contracting licensing, security clearances, and other suitability determinations; local, state, tribal, or federal law enforcement agencies; criminal justice agencies; and agencies responsible for national security or public safety. \lsdpriority49 \lsdlocked0 List Table 4 Accent 1;\lsdpriority50 \lsdlocked0 List Table 5 Dark Accent 1;\lsdpriority51 \lsdlocked0 List Table 6 Colorful Accent 1;\lsdpriority52 \lsdlocked0 List Table 7 Colorful Accent 1; PDF UTAH DEPARTMENT OF HEALTH Medical Cannabis Production Establishment Pursuant to the Federal Privacy Act of 1974 (5 USC 552a), the requesting agency is responsible for informing you whether disclosure is mandatory or. Payment for both the license application fee and the FBI/BCI fingerprint fee of $28.25 ($13.25 FBI/$15 BCI) must be made by credit card during the online license application process. \par \tab \hich\af5\dbch\af31505\loch\f5 (iii) an individual licensed to engage in the practice of nursing under Title 58, Chapter 31b, Nurse Practice Act; This includes foster care, proctor care, professional parent care and adoption for children in custody of a child welfare system, as well as private foster care and refugee foster care. No renewals will be required for as long as the applicant is actively employed in a licensed DHS or DHS contracted agency. 4. \par }{\rtlch\fcs1 \ab\af5 \ltrch\fcs0 \b\expnd0\expndtw-3\insrsid14438297 \hich\af5\dbch\af31505\loch\f5 R432-35-7. Background Checks | DSHS - Washington 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 \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 (Salt Lake City, UT) The Centers for Disease Control and Prevention (CDC) issued recommendations for vaccinating children 5 years of age and younger against COVID-19. e. 7468656d65312e786d6cec59cd8b1bc915bf07f23f347d97f5d5ad8fc1f2a24fcfda33b6b164873dd648a5eef2547789aad28cc56208de532e81c026e49085bd \par \tab \hich\af5\dbch\af31505\loch\f5 (i) an aged individual, as defined by department rule; or \par }{\*\themedata 504b030414000600080000002100e9de0fbfff0000001c020000130000005b436f6e74656e745f54797065735d2e786d6cac91cb4ec3301045f748fc83e52d4a 6e22206267313d226c743122207478313d22646b3122206267323d226c743222207478323d22646b322220616363656e74313d22616363656e74312220616363 Call 801-977-6800 to set up your appointment. \par \tab \hich\af5\dbch\af31505\loch\f5 (13) "Nursing Assistant" means\hich\af5\dbch\af31505\loch\f5 an individual who performs duties under the supervision of a nurse, which may include a nurse aide, personal care aide or certified nurse aide. ffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffff 8376bf330efaaff23606569ea58fdc16605ecdebde7f010000ffff0300504b0304140006000800000021000dd1909fb60000001b010000270000007468656d65 Background Check Authorization Form with Instructions (DSHS 09-653) The Background Check Authorization Form is completed by the applicant and given to the requesting entity. The Department may allow a . \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 ffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffff \lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Table Colorful 3;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Table Columns 1;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Table Columns 2;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Table Columns 3; Fingerprint Services for the Public - DPS - Criminal Identification (BCI) 1c57826650ab74c27eb3d20fc3667d1cd66ba341e31514161927f530bbb19fc00506dde4f7f67a7cefee3ed9ded1dc99b3a4caf4dd7c5513d777f7f5c6e1bb7b Completely fill out the demographic section at the bottom of the form AND attach a copy of your ID and social security card. \lsdpriority50 \lsdlocked0 Grid Table 5 Dark Accent 3;\lsdpriority51 \lsdlocked0 Grid Table 6 Colorful Accent 3;\lsdpriority52 \lsdlocked0 Grid Table 7 Colorful Accent 3;\lsdpriority46 \lsdlocked0 Grid Table 1 Light Accent 4; \par \tab \hich\af5\dbch\af31505\loch\f5 (c) a hospice; Live scan operator will sign and return a copy of the form to be uploaded into DACS by the screening agent. Once the application, forms and fees have been submitted to UDAF, UDAF will send the applicant a "Live Scan Fingerprint Authorization Form" to continue the process. \par \tab \hich\af5\dbch\af31505\loch\f5 \par \tab \hich\af5\dbch\af31505\loch\f5 (ix) transportation staff; overed provider must submit required information to the Department to initiate and obtain a clearance prior to the issuance of the provisional license. OL staff will check site rosters for ongoing screening compliance. \fs24\lang1033\langfe1033\loch\f5\hich\af5\dbch\af31505\cgrid\langnp1033\langfenp1033 \sbasedon0 \snext0 index 2;}{\s32\ql \li0\ri0\sl240\slmult0\nowidctlpar\tqr\tx9360\wrapdefault\hyphpar0\faauto\rin0\lin0\itap0 \rtlch\fcs1 \af5\afs24\alang1025 1-800-371-7897 Sources for Background Review. \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; Obtaining Utah Criminal History Records. The DSS will pay any fees required. \par \tab \hich\af5\dbch\af31505\loch\f5 (h) licensing and certification records of individuals licensed or certified by the Division of Occupat\hich\af5\dbch\af31505\loch\f5 ional and Professional Licensing under Title 58, Occupations and Professions; and I authorize the Utah Department of Human Services Office of Licensing to investigate and continually monitor my past and present child and adult abuse, neglect and exploitation records, law enforcement, driver license, and any information which may be pertinent to my application according to Utah Code 62A-2-120, 121, 122, and Administrative . \lsdsemihidden1 \lsdunhideused1 \lsdqformat1 \lsdpriority9 \lsdlocked0 heading 5;\lsdsemihidden1 \lsdunhideused1 \lsdqformat1 \lsdpriority9 \lsdlocked0 heading 6;\lsdsemihidden1 \lsdunhideused1 \lsdqformat1 \lsdpriority9 \lsdlocked0 heading 7; Sexual Violence Crisis Line Telephone: (850) 412-4503. 26-21-204, if an individual or covered individual has been convicted, has pleaded no contest, or is subject to a plea in abeyance or diversion agreement, for the following offenses, they may not have direct patient access: \hich\af5\dbch\af31505\loch\f5 e\hich\af5\dbch\af31505\loch\f5 arance as defined in R432-35-8, the Department may revoke an existing license or deny licensure for healthcare services in the residential setting. Crisis Line & Mobile Outreach Team Background checks on prospective employees: Keep required disclosures BCI cannot provide criminal or court-ordered fingerprinting services. \par \tab \hich\af5\dbch\af31505\loch\f5 (v) an executive; {\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;} If HCJDC has questions, please contact: Staff Name: Requesting DHS . Crisis Line & Mobile Outreach Team I certify that all of the personal Email: dhslicensing@utah.gov, HotlinesAbuse/Neglect of Seniors and Adults with Disabilities You will get an auto-generated email with a link to an online disclosure form to acknowledge. Child Abuse/Neglect Sexual Violence Crisis Line The child care staff member needs to keep a copy of their letter for any future child care employers. Wisconsin Background Check Forms & Publications Here's a variety of forms and publications to help you with the Background Check process. If you are asked to fill one out, chances are that you are one of the few people that the company is seriously considering hiring. Background Checks - Individual Providers | DSHS - Washington DACS will generate a fingerprint authorization form, which will be printed by the screening agent and provided to the applicant to take to the live scan fingerprinting location (list of locations may additionally generated through DACS as needed). Multi-Agency State Office Building A background check authorization form is basically the written consent for a background check needed by your potential employer. \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; 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 (a) employment status; rect Access Clearance System to initiate a clearance for each covered individual prior to being supplied by contract to a covered provider. The process for submitting these applications is as follows: Application: Fill out the application of the adoptive parent for the one-time clearance. \par {\fhimajor\f31533\fbidi \fswiss\fcharset177\fprq2 Calibri Light (Hebrew);}{\fhimajor\f31534\fbidi \fswiss\fcharset178\fprq2 Calibri Light (Arabic);}{\fhimajor\f31535\fbidi \fswiss\fcharset186\fprq2 Calibri Light Baltic;} \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 The needs of our communities continue to change as more and more people choose to make Utah their home. PDF EPARTMENT OF Lisa Sherych HEALTH AND HUMAN SERVICES - Nevada Email: dhslicensing@utah.gov, HotlinesAbuse/Neglect of Seniors and Adults with Disabilities They will enter your information in our DACS system, and you will get an auto-generated email with a link to an online disclosure form to acknowledge. \par \tab \hich\af5\dbch\af31505\loch\f5 (\hich\af5\dbch\af31505\loch\f5 6) A covered provider may not allow a covered individual who has been determined to be not eligible for direct patient access to be engaged in a position with direct patient access. \par \tab \hich\af5\dbch\af31505\loch\f5 (c)\hich\af5\dbch\af31505\loch\f5 a nursing care facility; \sbasedon0 \snext0 index 1;}{\s31\ql \li720\ri0\sl240\slmult0\nowidctlpar\tqr\tldot\tx9360\wrapdefault\hyphpar0\faauto\rin0\lin720\itap0 \rtlch\fcs1 \af5\afs24\alang1025 \ltrch\fcs0 \par \tab \hich\af5\dbch\af31505\loch\f5 (2) A covered contractor must ensure that the covered individual, being supplied by contract to a covered provider\hich\af5\dbch\af31505\loch\f5 : 0000000000000000000000000000000000000000000000000105000000000000}}. BGScreen@ahca.myflorida.com. 195 North 1950 West Some employment authorization documents issued by DHS include but are not limited to Form I-94 Arrival/Departure Record issued to asylees or work-authorized nonimmigrants (for example, H-1B nonimmigrants) because of their immigration status, Form I-571, Refugee Travel Document (PDF), an unexpired Form I-327, Reentry Permit , Form N-560 . dhslicensing@utah.gov. 3f2451eced0dae2c082e8761be9969bb979dc9136332de3168aa1a083ae995719ac16db8ec8e4052164e89d93b64b060828e6f37ed1567914b284d262452282e Complete social security numbers are needed for all children ages 12 and over to track their screenings in DACS. }{\rtlch\fcs1 \af5 \ltrch\fcs0 \expnd0\expndtw-3\insrsid14438297 Authority. What is a Background Check Authorization Form? - Secure Thoughts \par \tab \hich\af5\dbch\af31505\loch\f5 (2) The covered provider must ensure that the engaged covered individual: Routine Uses: During the processing of this application and for as long thereafter as your fingerprints and associated information/biometrics are retained in NGI, your information may be disclosed pursuant to your consent, and may be disclosed without your consent as permitted by the Privacy Act of 1974 and all applicable Routine Uses as may be published at any time in the Federal Register, including the Routine Uses for the NGI system and the FBIs Blanket Routine Uses. PDF Background Screening Policy - Utah Department of Health 000000300100005f72656c732f2e72656c73504b01022d00140006000800000021006b799616830000008a0000001c0000000000000000000000000019020000 Background Screening FAQ. If the individual is not eligible for cl {\fhiminor\f31506\fbidi \fswiss\fcharset0\fprq2{\*\panose 020f0502020204030204}Calibri;}{\fbiminor\f31507\fbidi \froman\fcharset0\fprq2{\*\panose 02020603050405020304}Times New Roman;}{\f529\fbidi \froman\fcharset238\fprq2 Times New Roman CE;} However, if your application has been submitted for longer than three weeks, you can request a status update by emailing cbsunit@utah.gov. \par \tab \hich\af5\dbch\af31505\loch\f5 (b) a long-term care hospital; 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. Department of Human Services, Office of Licensing to provide a copy of those results to me. We have transtioned to DACS (Direct Access Clearance System), a completely online background screening system. \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. It was the pioneering spirit of two remarkable individuals which would shape the future of public health in Utah for generations to come. \par \tab \hich\af5\dbch\af31505\loch\f5 (d) the Department of Human Services' Division of Child and Family Se\hich\af5\dbch\af31505\loch\f5 rvices Licensing Information System described in Section 62A-4a-1006; \hich\af5\dbch\af31505\loch\f5 n\hich\af5\dbch\af31505\loch\f5 existing license or deny licensure as a health care facility. OL Rule R501-14 outlines how OL makes employment determinations. You will first need the potential employee's authorization to run a background check using the form mentioned above. Child Abuse/Neglect \par \tab \hich\af5\dbch\af31505\loch\f5 (2) If th\hich\af5\dbch\af31505\loch\f5 1-800-273-TALK(8255) 2d51e252394309350d7e8264ec2239ddf0b9891b0b099e8e3065de78818570c93ce6b05ec3e90f21cdb8dd7e4a37898de4929cbb749e20c64ce4889d0f6394ac \par \tab \hich\af5\dbch\af31505\loch\f5 (b) juvenile court arrest, adjudication, and disposition records, as allowed under Section 78A-6-209; {\flominor\f31504\fbidi \froman\fcharset0\fprq2{\*\panose 02020603050405020304}Times New Roman;}{\fdbminor\f31505\fbidi \froman\fcharset0\fprq2{\*\panose 02020603050405020304}Times New Roman;} \widowctrl\ftnbj\aenddoc\hyphhotz950\trackmoves0\trackformatting1\donotembedsysfont0\relyonvml0\donotembedlingdata1\grfdocevents0\validatexml0\showplaceholdtext0\ignoremixedcontent0\saveinvalidxml0\showxmlerrors0 Human Services. also require a background screening for one-time clearance. If there are criminal or abuse/neglect history items to disclose, you are asked to do so in either an uploaded document via your screening agent or if you choose not to share details with them, you may submit directly to OL at cbsunit@utah.gov, please be sure to place the DACS application number and your name and dob on your email or we will not know whose application to link the disclosure to. Providing your fingerprints and associated information is voluntary; however, failure to do so may affect completion or approval of your application. \lsdpriority51 \lsdlocked0 List Table 6 Colorful Accent 3;\lsdpriority52 \lsdlocked0 List Table 7 Colorful Accent 3;\lsdpriority46 \lsdlocked0 List Table 1 Light Accent 4;\lsdpriority47 \lsdlocked0 List Table 2 Accent 4; 2. \par \tab \hich\af5\dbch\af31505\loch\f5 (h) a personal care agency. Mail the Authorization form, fingerprint card, and certified check or money order (personal checks are not accepted) for $65.00 made f9c6b10f3e4ebfe3566c25ab6b763a8792c9f14e7f7308b7dbd50c195f904fbfa919a175fa04431dd9cf58b73dcd6d4fe3ffdff73487f6f36d2773a8dfb8ed64 List of Certified Concealed Firearm Instructors, Information for Concealed Firearm Instructors, Concealed Firearm Permit Forms / Instructor Forms, Utah Missing Persons Clearinghouse Functions, Surety Bond and Liability Insurance Information, Documentation of Experience and Qualifications, Concealed Firearm Permit Instructor Applications, Employment/Volunteer Background Check Forms, Application to Become a Qualified Entity for Background Checks on Employees or Volunteers, Authorization to Transfer FBI Rapback Subscription NCPA/VCA, Authorization to Transfer FBI Rapback Subscription School Employees, Authorization to Transfer WIN Rapback Subscription Tow Truck Operators. \af5\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\loch\f5\hich\af5\dbch\af31505\cgrid\langnp1033\langfenp1033 \sbasedon0 \snext0 toc 2;}{\s23\ql \li720\ri720\sl240\slmult0\nowidctlpar \par \tab \hich\af5\dbch\af31505\loch\f5 (ii) any felony, class A or B conviction under Utah Criminal Code 76-6-106(2)(b)(i)(A) Criminal Mischief - Human Life; After 60 days if not linked to another licensed setting, the RapBack subscription will be closed and a new DACS application will be necessary to re-open for employment in a DHS licensed agency. \expnd0\expndtw-3\insrsid14438297 1-800-897-LINK(5465), Abuse/Neglect of Seniors and Adults with Disabilities. \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 \par \tab \hich\af5\dbch\af31505\loch\f5 (f) the Department of Human Services' Division of Aging and Adult Services vulnerable adult abuse, neglect, or exp\hich\af5\dbch\af31505\loch\f5 loitation database described in Section 62A-3-311.1; \par \tab \hich\af5\dbch\af31505\loch\f5 (b) a covered provider for services within the scope of the health facility license. 7aca147a3e08ad9246bbf33e1637f535c8ede6069a9a9982a6de65cf6f35430899395af5fc251c1ac363b282d811ea3717a211dcbccc25cf36fc4d32cb8a0b39 }{\rtlch\fcs1 \af5 \ltrch\fcs0 \expnd0\expndtw-3\insrsid14438297 \lsdsemihidden1 \lsdunhideused1 \lsdlocked0 table of authorities;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 macro;\lsdsemihidden1 \lsdlocked0 toa heading;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 List; \par \tab \hich\af5\dbch\af31505\loch\f5 (i) whom a covered body engages; and 1-855-323-DCFS(3237) MVR screening requires an additional consent form. 000000000000000000009d0a00007468656d652f7468656d652f5f72656c732f7468656d654d616e616765722e786d6c2e72656c73504b050600000000050005005d010000980b00000000} \par \tab \hich\af5\dbch\af31505\loch\f5 (E) 76-10-1201 to 1229.5, Pornographic and Harmful Materials and Performances; I understand that my personal information including name, DOB, SSN and fingerprints will be used for the purpose of . \par \tab \hich\af5\dbch\af31505\loch\f5 (a) by employmen\hich\af5\dbch\af31505\loch\f5 t; Health, Family Health and Preparedness, Licensing. \hich\af5\dbch\af31505\loch\f5 c\hich\af5\dbch\af31505\loch\f5 onsidered: Results from the in-state and out-of-state screening process will be mailed to providers in the form of a letter once completed. 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). ffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffff {\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;} Only agencies with OL administrative approval and a documented exception to live scan fingerprinting will be allowed to submit hard card prints rolled at a public safety office. Missing or Incorrect State (Non-Federal) Information. This needs to be obtained prior to submitting the application to the office and the results included with the application to the Office. . \par \tab \hich\af5\dbch\af31505\loch\f5 (6) A covered contractor may not supply to a covered provider a covered individual who has been determined to be not eligible to have direct patient access. {\fhiminor\f31571\fbidi \fswiss\fcharset161\fprq2 Calibri Greek;}{\fhiminor\f31572\fbidi \fswiss\fcharset162\fprq2 Calibri Tur;}{\fhiminor\f31573\fbidi \fswiss\fcharset177\fprq2 Calibri (Hebrew);} Background Screening -- Health Facilities. {\fdbmajor\f31525\fbidi \froman\fcharset186\fprq2 Times New Roman Baltic;}{\fdbmajor\f31526\fbidi \froman\fcharset163\fprq2 Times New Roman (Vietnamese);}{\fhimajor\f31528\fbidi \fswiss\fcharset238\fprq2 Calibri Light CE;} The act requires the health facilities and Medicaid community based waiver providers complete a caregiver criminal history screening no later than 20 calendar days after the first day of employment. \par \tab \hich\af5\dbch\af31505\loch\f5 (ii) the severity of offense; and Sexual Violence Crisis Line \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 (b) a small health care facility; Code R432-35 - Background Screening - Health Facilities; Utah Admin. Criminal Background Screening Authorization Form. \lsdpriority49 \lsdlocked0 Grid Table 4 Accent 2;\lsdpriority50 \lsdlocked0 Grid Table 5 Dark Accent 2;\lsdpriority51 \lsdlocked0 Grid Table 6 Colorful Accent 2;\lsdpriority52 \lsdlocked0 Grid Table 7 Colorful Accent 2; Utah Domestic Violence The FBI will contact appropriate agencies in an attempt to verify or correct challenged entries for you. \b\expnd0\expndtw-3\insrsid14438297 \hich\af5\dbch\af31505\loch\f5 R432. \par \tab \hich\af5\dbch\af31505\loch\f5 (10) "Disabled individual" means an individual\hich\af5\dbch\af31505\loch\f5 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. Crisis Line & Mobile Outreach Team \par \tab \hich\af5\dbch\af31505\loch\f5 (i) types and number; The screened professions listed below require background screening at initial licensure and/or renewal of licensure. \lsdsemihidden1 \lsdunhideused1 \lsdlocked0 List 4;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 List 5;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 List Bullet 2;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 List Bullet 3; 13) of the Utah State Bulletin. \lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Table Web 3;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Balloon Text;\lsdpriority39 \lsdlocked0 Table Grid;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Table Theme;\lsdsemihidden1 \lsdlocked0 Placeholder Text; 000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000ffffffffffffffffffffffff000000000000000000000000000000000000000000000000 9cb2400825e982c78ec7a27cc0c8992416c9d8b2a755fbf74cd25442a820166c2cd933f79e3be372bd1f07b5c3989ca74aaff2422b24eb1b475da5df374fd9ad Utah Administrative Code; Topic - Health; Title R432 - Family Health and Preparedness, Licensing; .