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The An 048 Arizona form, issued by the Arizona Department of Economic Security's Child Protective Services (CPS) Central Registry, serves a crucial role for adoptive families navigating the clearance process. It is a vital step in ensuring the safety and welfare of children by thoroughly examining the backgrounds of all household members involved in an adoption. Confidential and legally protected, the information gathered through this form is only disclosed to individuals authorized by specific state and federal laws. By meticulously collecting details such as names, birthdates, Social Security numbers, addresses, and any other names used by adoptive parents and other adult household members, the form offers a comprehensive means to check for any history of prior reports within the CPS Central Registry. Further, it extends to encompassing the names and birthdates of all children residing in the household. The integrity of this process is underscored by the requirement for all information to be certified as true and accurate by the signatures of the adopting parents and other adult household members. This procedure culminates in a review by CPS personnel, concluding with the verification of whether any substantiated reports exist, thereby embodying Arizona's commitment to safeguarding the interests and well-being of children and adoptive families alike.

An 048 Arizona Preview

AN-048 (6-06)

ARIZONA DEPARTMENT OF ECONOMIC SECURITY

Child Protective Services Central Registry, 050C-3

P.O. Box 44240 • Phoenix, AZ 85064-4240

ADOPTIVE FAMILIES CENTRAL REGISTRY RECORDS CLEARANCE

Child Protective Services (CPS) records are confidential and can be released only to those individuals permitted by state (A.R.S. § 8-807) and federal law. This form is to be completed for all household members. The requested information will be used to check the Child Protective Services Central Registry for any history of prior reports. Mail to address above.

ADOPTIVE FATHER’S NAME (Last, First, Middle)

BIRTHDATE

SOC. SEC. NO.

 

 

 

OTHER NAMES USED

 

 

 

 

 

ADOPTIVE FATHER’S ADDRESS (No., Street, City, State, ZIP)

 

 

 

 

 

ADOPTIVE MOTHER’S NAME (Last, First, Middle)

BIRTHDATE

SOC. SEC. NO.

 

 

 

OTHER NAMES USED (Include maiden name and prior married names)

 

 

 

 

 

ADOPTIVE MOTHER’S ADDRESS (No., Street, City, State, ZIP)

 

 

 

 

 

OTHER ADULT HOUSEHOLD MEMBER’S NAME (Last, First, Middle.)

BIRTHDATE

SOC. SEC. NO.

 

 

 

OTHER NAMES USED (Include maiden name and prior married names)

 

 

 

 

OTHER ADULT HOUSEHOLD MEMBER’S ADDITIONAL ADDRESS (No., Street, City, State, ZIP)

 

 

 

 

OTHER ADULT HOUSEHOLD MEMBER’S NAME (Last, First, Middle)

BIRTHDATE

SOC. SEC. NO.

 

 

 

OTHER NAMES USED (Include maiden name and prior married names)

 

 

OTHER ADULT HOUSEHOLD MEMBER’S ADDITIONAL ADDRESS (No., Street, City, State, ZIP)

Children’s Names (Include birth, adopted and any other children living in household)

CHILD’S NAME (Last, First, Middle)

CHILD’S NAME (Last, First, Middle)

CHILD’S NAME (Last, First, Middle)

CHILD’S NAME (Last, First, Middle)

CHILD’S NAME (Last, First, Middle)

BIRTHDATE

BIRTHDATE

BIRTHDATE

BIRTHDATE

BIRTHDATE

I certify that all information provided is true and accurate to the best of my knowledge.

ADOPTING FATHER’S SIGNATURE

 

 

 

DATE

 

 

 

 

 

 

 

 

 

ADOPTING MOTHER’S SIGNATURE

 

 

 

DATE

 

 

 

 

 

 

 

 

 

OTHER ADULT HOUSEHOLD MEMBERS’ SIGNATURE

 

 

 

DATE

 

 

 

 

 

 

 

 

 

NAME OF AGENCY REQUESTING CENTRAL REGISTRY RECORDS CLEARANCE

 

AREA CODE AND PHONE NO.

DATE

 

 

 

 

 

 

 

 

 

CASE MANAGER’S SIGNATURE

 

 

 

DATE

 

 

 

 

 

 

 

 

 

NAME AND ADDRESS OF AGENCY TO RECEIVE INFORMATION FROM

 

TO BE COMPLETED BY CPS PERSONNEL

CENTRAL REGISTRY (THIS BLOCK MUST BE COMPLETED)

 

 

Central Registry information checked

 

 

 

 

 

 

 

 

 

 

 

 

There were no substantiated reports.

 

 

report(s) attached

SIGNATURE OF PERSON CHECKING CENTRAL REGISTRY

DATE

See reverse for Americans with Disabilities Act (ADA) disclosure.

Equal Opportunity Employer/Program ̶ Under Titles VI and VII of the Civil Rights Act of 1964 (Title VI & VII), and the Americans with Disabilities Act of 1990 (ADA), Section 504 of the Rehabilitation Act of 1973, and the Age Discrimination Act of 1975, the Department prohibits discrimination in admissions, programs, services, activities, or employment based on race, color, religion, sex, national origin, age, and disability. The Department must make a reasonable accommodation to allow a person with a disability to take part in a program, service or activity. For example, this means if necessary, the Department must provide sign language interpreters for people who are deaf, a wheelchair accessible location, or enlarged print materials. It also means that the Department will take any other reasonable action that allows you to take part in and understand a program or activity, including making reasonable changes to an activity. If you believe that you will not be able to understand or take part in a program or activity because of your disability, please let us know of your disability needs in advance if at all possible. To request this document in alternative format or for further information about this policy, contact (602) 542-3598; TTY/TTD Services: 7-1-1.

File Properties

Fact Detail
Form Number AN-048 (6-06)
Issuing Department Arizona Department of Economic Security
Purpose Adoptive Families Central Registry Records Clearance
Confidentiality Statement Child Protective Services (CPS) records are confidential, only releasable per state (A.R.S. § 8-807) and federal laws.
Applicability All household members involved in an adoption process.
Information Required Personal and identifying information for each household member, including children living in the household.
Governing Law A.R.S. § 8-807
Non-Discrimination Policy In compliance with Civil Rights Act of 1964 (Title VI & VII), ADA of 1990, Section 504 of the Rehabilitation Act of 1973, and the Age Discrimination Act of 1975, it prohibits discrimination and requires accommodations for disabilities.

Instructions on Utilizing An 048 Arizona

Filling out the AN-048 Arizona form is an important step for adoptive families to ensure compliance with the Arizona Department of Economic Security's requirements. This form aids in the clearance process from the Child Protective Services Central Registry. It's imperative for every household member's information to be accurately presented to avoid delays or complications in the adoption process. By following the step-by-step guide below, you can complete the form confidently and correctly.

  1. Start by entering the Adoptive Father's Name in the designated space, including Last, First, and Middle names.
  2. Fill in the Adoptive Father’s Birthdate and Social Security Number (SOC. SEC. NO.).
  3. List any Other Names Used by the adoptive father, including maiden names or names from previous marriages if applicable.
  4. Provide the Adoptive Father’s Address, ensuring to include the Number, Street, City, State, and ZIP code.
  5. Repeat steps 1 through 4 for the Adoptive Mother, ensuring all her details are filled out in their respective fields.
  6. For any Other Adult Household Members, repeat steps 1 through 4. Include all information such as name, birthdate, social security number, other names used, and addresses. If there are multiple other members, use the additional space provided.
  7. Under the Children’s Names section, list all children in the household, including those who are birthed, adopted, and any other children living in the household. Include their Last, First, and Middle names and Birthdates.
  8. Ensure that the Adopting Father and Adopting Mother sign and date the form in the designated spaces at the bottom of the page.
  9. If there are other adult household members, their signatures and the date must also be included in the provided space.
  10. Complete the section designated for the Name of Agency Requesting Central Registry Records Clearance, including the Area Code and Phone No., and have the Case Manager sign and date the form.
  11. Before mailing the form, review all the information to ensure accuracy and completeness.
  12. Send the completed form to the address provided at the top, which is Child Protective Services Central Registry, 050C-3 P.O. Box 44240 • Phoenix, AZ 85064-4240.

After mailing the form, the Child Protective Services Central Registry will process your information. It is designed to screen for any history of prior reports within the household. Cooperation and accuracy when completing this form are crucial for a smooth process. Be sure to keep a copy of the filled-out form for your records and await further communication from the Arizona Department of Economic Security regarding the next steps in your adoption journey.

Listed Questions and Answers

What is the AN-048 Arizona form used for?

The AN-048 form is specifically designed for adoptive families in Arizona, fulfilling the crucial role of conducting a background check through the Child Protective Services Central Registry. This process ensures that prospective adoptive parents and other adult household members do not have a history of substantiated child abuse or neglect reports. The completion and submission of this form are essential steps in the adoption process, safeguarding the well-being of children entering new familial environments.

Who needs to complete the AN-048 Arizona form?

All members of a household seeking to adopt a child in Arizona must complete the AN-048 form. This includes the adoptive mother and father, as well as any other adults living in the home. The form is designed to collect detailed information from each individual, including names, birthdates, social security numbers, and any other names previously used, facilitating a thorough check of the Child Protective Services Central Registry.

Where should the AN-048 form be mailed?

Once fully completed, the AN-048 form should be mailed to the Arizona Department of Economic Security, specifically to the address provided on the form: Child Protective Services Central Registry, 050C-3, P.O. Box 44240, Phoenix, AZ 85064-4240. It's crucial to ensure that the form is filled out accurately and completely to prevent any delays in the processing time.

What happens after submitting the AN-048 form?

After the AN-048 form is submitted, the Child Protective Services Central Registry conducts a detailed search for any previous reports of child abuse or neglect associated with the individuals listed on the form. If no substantiated reports are found, the process moves forward. In the event that a report is found, further investigation and potentially additional steps will be required to ensure the safety and suitability of the adoptive environment.

Is the information provided on the AN-048 form confidential?

Yes, the information collected on the AN-048 form is held in the strictest confidence, in line with state (A.R.S. § 8-807) and federal law. Access to these records is limited to individuals explicitly authorized by these legal statutes, ensuring the privacy and protection of the individuals involved.

Can someone outside of Arizona access the Central Registry records using the AN-048 form?

The use of the AN-048 form is specifically designed for the Arizona Child Protective Services Central Registry records clearance process. Individuals or agencies outside of Arizona would need to consult with their own state's procedures and regulations to access similar records or inquire about individuals' histories with child protective services. Cross-state checks involve separate protocols and cooperation between states.

How long does the process take after submitting the form?

The duration of the background check process after the AN-048 form has been submitted can vary based on several factors, including the current workload of the Child Protective Services Central Registry staff and the clarity of the information provided. While some checks may be completed relatively quickly, applicants are encouraged to allow sufficient time for processing and to submit their forms well in advance of any adoption deadlines.

What actions are required if there are substantiated reports found?

If the Central Registry check reveals substantiated reports of child abuse or neglect, the specific actions required will vary depending on the nature of the reports and the regulations governing adoption in Arizona. Generally, this may involve further investigation, the provision of additional information, or other steps to address concerns and verify the safety of the adoptive home environment. Each case is assessed individually, with the paramount concern being the welfare of the child or children involved.

Common mistakes

When filling out the AN-048 Arizona form for Child Protective Services Central Registry records clearance, individuals often make mistakes that can lead to delays or incorrect processing of their request. Awareness and attention to detail can significantly mitigate these issues. Below is an enumeration of common errors:

  1. Not providing complete names: It's crucial to include full legal names—last, first, and middle—of all adopting parents and other adult household members. Omitting any part can cause discrepancies and delay the verification process.
  2. Failure to list all other names used: All previous names, including maiden names and prior married names, must be documented. This oversight often leads to incomplete background checks, as records could exist under other names.
  3. Omitting or incorrectly providing Social Security numbers: Social Security numbers are essential for accurately identifying individuals in the CPS Central Registry. Errors in these numbers can lead to the wrong individual's records being pulled or not finding records that do exist.
  4. Incomplete addresses: The form requires current addresses in full, including the number, street, city, state, and ZIP code for both adoptive parents and other adult household members. Missing or partial addresses can lead to processing delays.
  5. Leaving birthdates blank or entering them incorrectly: Accurate birthdates are critical for identifying records. Mistakes in this area can easily result in the mismatch of records or the inability to find relevant information.
  6. Not listing all children in the household: The form requires the names and birthdates of all children in the household, including birth, adopted, and any other children living in the household. Failure to include any child can be seen as an intentional omission and potentially hinder the clearance process.
  7. Misplacing signatures and dates: The form requires the signatures and dates from the adopting father, adopting mother, and other adult household members. These are often overlooked or placed in the wrong section, leading to the form being returned for correction.
  8. Forgetting to list the name and address of the agency requesting and to receive information: The clearance process is initiated for a reason, often at the request of an agency. Not including the requesting and receiving agency's information can halt the process until corrected.

Avoiding these mistakes requires a careful review of the form before submission, ensuring all information is complete, accurate, and placed correctly. This attention to detail ensures that the process moves as smoothly as possible, supporting a swift and accurate records clearance.}

Documents used along the form

In the journey of adopting a child in Arizona, the AN-048 form serves as a crucial step for families to ensure they meet the safety and welfare standards required by the Arizona Department of Economic Security. However, this form is just one piece of a larger puzzle. To complete the adoption process, several additional forms and documents commonly accompany the AN-048 form, each playing an essential role in creating a comprehensive background check and facilitating a smooth adoption journey.

  • Application for Adoption: This initial document outlines basic information about the prospective adoptive parents, including names, ages, employment history, and reasons for wanting to adopt. It serves as the starting point in the adoption process.
  • Home Study Report: A comprehensive review carried out by a licensed agency, the home study report assesses the living environment, family dynamics, financial stability, and overall readiness of the adoptive family to welcome a child into their home.
  • Medical Health Statements: These forms provide detailed records of the physical and mental health of all members of the prospective adoptive household, ensuring that they are capable of caring for a child.
  • Fingerprint Clearance Card: Arizona requires all adult members of the prospective adoptive family to undergo fingerprinting to check for criminal history, emphasizing the safety and protection of children.
  • Financial Statement: This document outlines the family's financial resources to demonstrate their ability to support an adopted child, including income, expenses, assets, and liabilities.
  • References: Letters or forms completed by non-family members who can attest to the character, stability, and parenting abilities of the prospective adoptive parents, providing an external perspective on their suitability to adopt.

Together with the AN-048 form, these documents build a profile of the prospective adoptive family that helps the Arizona Department of Economic Security make informed decisions in the best interest of children needing homes. The process, while thorough, ensures that every child placed for adoption finds a safe, loving, and stable home. Bringing a new member into your home is a beautiful journey that requires meticulous preparation, and understanding these essential steps can help make the transition smoother and more joyful for everyone involved.

Similar forms

The AN-048 Arizona form is a procedural document for adoptive families needing clearance from the Child Protective Services Central Registry. Its function resembles that of an FBI Background Check, as both are intended to screen individuals' histories for specific criteria that might disqualify them from certain activities. The FBI Background Check, however, spans a broader range of criminal activities across the entire country, making it a tool for employers, among others, to assess potential risks associated with hiring new employees. Conversely, the AN-048 form focuses solely on child welfare concerns within Arizona, tailoring its inquiry specifically to the wellbeing of children in prospective adoptive homes.

Similarly, the form shares common ground with the Central Registry Check present in other states. While the specifics of each state’s form can differ, the overarching goal remains the same: to ensure the safety of children by preventing those with a history of abuse or neglect from taking custody. Each state maintains its own database, much like Arizona's Central Registry, where records of child abuse and neglect are kept. The process for checking these registries provides an additional layer of protection for children, mirroring the precautionary measures taken by the AN-048 form, albeit tailored to the legal and procedural frameworks of their respective states.

The AN-048 is also akin to Foster Parent Applications in its intention to safeguard child welfare. Foster Parent Applications are scrutinized to evaluate the suitability of a foster home, including background checks similar to those conducted through the AN-048 form for adoptive parents. Both documents serve as vital steps in the protective frameworks developed to ensure children are placed in safe, nurturing environments, with each acting as a gatekeeper in their respective areas of child welfare placement.

Employment Verification Forms share some similarities with the AN-048 form, particularly in the collection and verification of personal and sensitive information. These forms are used by employers to confirm a candidate's employment history, ensuring the information provided is accurate and true. Like the AN-048, which seeks to verify the backgrounds of adoptive family members for the safety of children, Employment Verification Forms uphold the integrity of the hiring process, preventing fraudulent or deceptive practices.

Similarly, the form's emphasis on checking past records for the safety of children bears resemblance to the purpose behind the Sex Offender Registry Checks. These checks are designed to protect communities by informing them about individuals convicted of sex offenses. When adopting or fostering a child, it's critical to ensure that the child is placed in a safe environment, free from potential harm. The Sex Offender Registry Check, like the AN-048, acts as a preventive measure against placing children in potentially harmful situations.

The form shares objectives with Immigrant Sponsorship Forms used in immigration processes. Such forms require a sponsor to provide detailed personal information, similar to how the AN-048 form requires adoptive parents to furnish personal details. The rationale behind both documents is to assess the capability and suitability of the individual—whether adopting a child or sponsoring an immigrant—to fulfill their respective roles responsibly. Though the contexts differ vastly, the underlying principle of vetting individuals to ensure they are fit for a significant responsibility connects the two processes.

Lastly, Medical Examination Forms for school enrolment or employment likewise parallel the AN-048 form in their purpose of safeguarding wellbeing. These forms evaluate whether individuals are physically and medically fit for participating in educational activities or work environments. The analogy lies in the precautionary motive shared with the AN-048 form, which assesses backgrounds for the emotional and physical safety of children entering new adoptive homes. Each document, in its respective context, functions to prevent foreseeable problems by validating the qualifications or histories of the individuals involved.

Dos and Don'ts

When filling out the AN-048 Arizona form for Child Protective Services Central Registry Records Clearance, there are specific actions you should and shouldn't do to ensure the process is completed accurately and efficiently. Here's a comprehensive guide:

Things You Should Do
  • Provide accurate information: Ensure all the names, birthdates, and Social Security numbers are correctly filled in without any typos or mistakes.
  • List all household members: Include every person who lives in the household, using their full legal names and any other names they have used in the past.
  • Double-check addresses: Verify that the addresses for all listed household members are current and correctly formatted.
  • Include all children's information: Fill in the sections for all children in the household, including birth, adopted, and any other children living in the household, with their full names and birthdates.
  • Sign the form: Make sure the adopting father, adopting mother, and any other adult household members sign the form to certify that the information provided is true and accurate to the best of their knowledge.
  • Provide contact information for the requesting agency: Include the name, address, area code, and phone number of the agency requesting the central registry records clearance.
Things You Shouldn't Do
  • Leave sections incomplete: Do not skip any sections or leave blanks; if a section does not apply, enter "N/A" to indicate this.
  • Guess on details: Avoid making guesses on birthdates, Social Security numbers, or previous addresses. It's crucial to verify and provide accurate information.
  • Use nicknames or shortened names: Instead of nicknames or abbreviations, use full legal names as they appear on official documents.
  • Forget to list previous married names or maiden names: Ensure that all previous names, including maiden and previously married names, are listed to facilitate a comprehensive check.
  • Sign without reviewing: Do not sign the form until you have double-checked all the information for accuracy. Signing the form certifies that all information is correct.
  • Send the form to the wrong address: Double-check the mailing address for the Arizona Department of Economic Security to ensure that the form reaches the intended destination.

Misconceptions

When it comes to the Arizona Department of Economic Security's Form AN-048, which deals with Adoptive Families Central Registry Records Clearance, there are several misconceptions that need to be clarified. Understanding these misconceptions is critical for families navigating the adoption process in Arizona.

  • Misconception 1: The form is only for adoptive parents.
    While it may seem that the form is solely for the use of adoptive parents given its title, it actually requires information from all adult members living in the household. This includes not only the adoptive parents but also any other adults residing in the home, ensuring a comprehensive check is performed for the safety of the child.
  • Misconception 2: Personal information is shared freely.
    Concerns often arise about the level of personal information requested on the form. However, it is important to understand that Child Protective Services (CPS) records are confidential and can only be released to individuals permitted by state and federal law. The requested information is used strictly for checking the CPS Central Registry for any history of prior reports.
  • Misconception 3: Submission of the form guarantees adoption approval.
    Submitting Form AN-048 is a necessary step in the adoption process, but it does not guarantee approval. The form's primary purpose is to assess the safety of the home environment for a child by checking for any substantiated reports in the CPS Central Registry. Other factors are also considered in the adoption approval process.
  • Misconception 4: Only children being adopted need to be listed on the form.
    It is a common misunderstanding that only the names of the children being adopted are required on the form. In reality, the names and birthdates of all children living in the household, including biological, adopted, and any other children under the household's care, must be listed. This comprehensive approach helps ensure the safety and well-being of every child in the home.

Clarifying these misconceptions is essential for prospective adoptive families to understand the legal requirements and implications of the AN-048 form in Arizona. By providing accurate and complete information as requested, families can navigate the adoption process more smoothly and ensure a safe environment for their new family member.

Key takeaways

  • The AN-048 form is crucial for adoptive families in Arizona, serving as a Central Registry Records Clearance through the Department of Economic Security, specifically for Child Protective Services (CPS).
  • Completion of this form is mandatory for all household members when adopting, as it checks for any history of prior reports against individuals in the CPS Central Registry.
  • Information required on the form includes full names, birthdates, social security numbers, and addresses of all adult household members, alongside the names and birthdates of all children in the household.
  • The form obligates individuals to disclose any other names they have used, which includes maiden names and any previous married names, ensuring a thorough check can be accomplished.
  • Both adopting parents and other adult household members must sign the form, certifying that all provided information is accurate to the best of their knowledge.
  • An agency case manager also signs the form, indicating the information request for Central Registry Records Clearance and the form includes a section to be completed by CPS personnel about the Central Registry check outcomes.
Note: It's essential for those completing the form to be thorough and honest with the information provided, as any inaccuracies can delay or impact the adoption process. Furthermore, the form highlights the rights and reasonable accommodations for individuals with disabilities, under various federal laws including the Americans with Disabilities Act (ADA), a reflection of the form's compliance with national standards for equal opportunity.
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