Help us protect Louisiana's children. signNow empowers organizations to speed up document processes, reduce errors, and improve collaboration. Create an account with signNow to legally eSign your templates. hbbd```b``&@$d% ,"Ne" R ,V $SE&(fI{`v,tnfL@8$L ------> We keep all the papers! CFS 689 Rev 1/2012 State of Illinois Department of Children and Family Services AUTHORIZATION FOR BACKGROUND CHECK Child Abuse and Neglect Tracking System (CANTS) For Programs NOT Licensed by DCFS. This page includes all DCFS forms available online. Guarantees that a business meets BBB accreditation standards in the US and Canada. %%EOF The form is specific to the candidate's desired role at CPS, such as an employee, volunteer, or vendor. Put the date and place your e-signature. USLegal fulfills industry-leading security and compliance standards. If there is a unique barcode on the document somewhere I would theorize there is an even higher likelihood of it being scanned - the document is of enough value to be printed individually which costs more, which means it is likely going to be used on the capture side. Go to the Chrome Web Store and add the signNow extension to your browser. ago. www.healthandwelfare.idaho.gov . This page includes all DCFS forms available online. This means they will talk and work together. No matter which way you choose, your forms will be legally binding. Please contact your licensing representative. When the health care employer prints the fingerprint form, information on all currently-authorized livescan vendors will appear on the form. Cants 689 is not the form you're looking for? Get access to thousands of forms. Please contact your licensing representative. their name is listed on the HFS Office of the Inspector General Sanction List as not authorized for employment unlesstheir employment is approved byHFS. 401: Standards for Chilld Welfare Agencies, 377: Facilities and Programs Exempt from Licensure, 381: Advertising by Unlicensed Facilities, Interim Conditional Early Childhood Teacher Policy, CFS 428 Application/Record of Child Information, CFS 1050-51 Summary of Licensing Standards for Day Care Homes, CFS 1050-52 Summary of Licensing Standards for Day Care Centers, CFS 1050-53 Summary of Licensing Standards for Group Day Care Homes, CANTS 22 Acknowledgment of Mandated Reporter Status, CFS 508 Report of Persons Employed in a Childcare Facility, CFS 508-01 Info on a Person Employed in a Childcare Facility, CFS 583-A Certificate of Inspection for Unsafe Childrens Products (FACILITIES), CFS 583-B Certificate of Inspection for Unsafe Childrens Products (HOME), CFS 597 Application for child care facility license, CFS 602 Medical Report on an Adult in a Childcare Facility, CFS 671 Childcare Facility Driver Application, CFS 718-B Authorization for Background Check For Childcare, CFS 718-B Spanish Authorization for Background Check For Childcare, CFS 689 Authorization for Background Checks for Programs NOT Licensed by DCFS, CFS 2026 Home Safety Checklist for Parents. Mail: DCF-Background Check Unit,505 Hudson Street,Hartford, CT 06106. (e.g. Work Location: 1911 S Indiana Ave Chicago, IL 60616-1310. When there is history, a letter is sent to the requesting agency with detailed information about thefindings. :). Providers can request UCIA name-based background check through the Illinois State Police web site. A background check may reveal various details about a candidate's past, including criminal history, civil court history, educational and employment history. When a report is made to the Department of Children and Family Services alleging child abuse or neglect, an investigation ensues. Open it using the cloud-based editor and begin adjusting. endstream endobj startxref completion of background checks required by Idaho statutes/ administrative rules. Please note that you must set up your country and primary language correctly in order to view this project. CFS cases go to Juvenile Court for two main reasons: To get an order allowing CFS to remove or keep children from returning to the parent's home. Additionally, questions can be submitted to email, The failed individual can send an appeal request in. Please contact your licensing representative. Requests for an agency clearance for the purpose of adoption are submitted to the Adoption Petition Worker in the respective region. The Department of Children & Families Background Checks Unit will perform a search of the departments Central Registry and Child Abuse & Neglect history on an individual who will be working or proving some kind of service directly or indirectly to children and families. Additional information regarding agency background clearances can be obtained: Help us protect Louisiana's children. It'll take less than 5 minutes. Line 2: If you are the provider, circle "Yes". Enjoy smart fillable fields and interactivity. Middle Gender: Male. Find the extension in the Web Store and push, Click on the link to the document you want to design and select. Select the area where you want to insert your signature and then draw it in the popup window. The Department of Children & Families hasa dedicated Unit, located within the Careline, assigned to process the background checks. When requesting background checks for Child Protective Services (CPS) investigations or allegations of child abuse or neglect (CAN) (National Crime Information Center (NCIC) Purpose Code C): Requestors may call the DCYF NCIC Background Check Unit (BCU) at 1-800-998-3898 prior to either: Going to the home. An \u201cindicated\u201d finding means that CFS has concluded there is credible evidence that a child has been abused or neglected. 14. whelp85 3 mo. Employ persons havingan Illinois State Police fingerprint criminal background check result reported to theHealth Care Worker Registry (HCWR) that showsno disqualifying criminal convictions unlessa waiver for that conviction is granted by the Illinois Department of Public Health (IDPH). Use our detailed instructions to fill out and eSign your documents online. If after two weeks you do not receive the results of any form(s) you sent in, please use your agency dashboard via the portal to request an update. Any forms that do not meet these guidelines will be returned to the requestor and or agency without processing. Wisconsin Background Check Forms & Publications . The Louisiana Child Abuse and Neglect Clearance System (CANS) is the mechanism to request other types of searches. If you care about children and families, there is a place for you at DCFS. Planning, Wills %PDF-1.6 % _Check_for_Programs_NOT_Licensed _by_DCFS_(Fillable).pdf . The worker must check the form for completeness and accuracy, confirm that the person (if age 18 or older . If there is no history for the individual, a statement of No Record Found is stamped, dated and initialed onto the letter. DZIECI I SPRAW RODZINNYCH (DEPARTAMENT DCFS), CFS 403-D Adoptive Parents' Rights and Responsibilities in Illinois, CFS 403-D/P PRAWA I OBOWIZKI RODZICW ADOPCYJNYCH W STANIE ILLINOIS, CFS 403-E Birth Parents' Right and Responsibilities in Illinois, CFS 403-E/P PRAWA I OBOWIZKI RODZICW BIOLOGICZNYCHW STANIE ILLINOIS, CFS 407-3 Community College Payment Program (Fillable), CFS 407-6 NIU Educational Access Project for DCFS Referral Form for Education Assistance (Fillable), CFS 407-7 Request for DCFS Guardians Approval for Home Schooling, CFS 411-A Report of Investigation for Adoption, CFS 411-G Report of Investigation for Guardianship, CFS 414 Letter to the Judge-Costs Incurred during a Child Custody Investigation (Fillable), CFS 415 Consent for Ordinary and Routine Medical and Dental Care, CFS 417 Psychology Department Testing Referral Form, CFS 417-B Psychological or Neuropsychological Testing/Parenting Capacity Assessment Feedback Reimbursement Form, CFS 417-D Comprehensive Diagnostic Assessment, CFS 417-E Request for Psychiatric Evaluation Following Therapy, CFS 418-J Checklist for Children at Initial Placement, CFS 418-L Pre-Screen for DCFS Ward with Intellectual Disabilities, CFS 428 Application/Record of Child Information, CFS 431 Consent of Guardian to Medical-Surgical Treatment, CFS 431-1 Consent of Guardian to Mental Health Treatment (Fillable), CFS 431-2 Outpatient Psychiatry Request Form, CFS 431-A Psychotropic Medication Request, CFS 431-A Psychotropic Medication Request Fax Cover Sheet, CFS 431-D Request for Copy of Psychotropic Medication (or Other*) Consent, CFS 433-1 Waiver of Religious Faith and Preference in Adoptive Placement, CFS 435 Final and Irrevocable Surrender to an Agency for Purposes of Adoption of a Born Child, CFS 435-2 Surrender To An Agency For Purposes Of Adoption Of An Unborn Child(ren), CFS 436-1-A Consent by an Agency for the Adoption of a Minor Child, CFS 437-3A Denial of Paternity with Entry pf Appearance and Consent to Adoption, CFS 438, Scholarship Application (Fillable), CFS 438, Scholarship Application (with lines to complete by hand), CFS 438-A Tuition and Mandatory Fee Waiver Program (Fillable), CFS 440-4 Guide to Risk Factors for Substance Affected Families & Substance Exposed Infants, CFS 440-6 Referral for Adult Alcohol and Other Drug Treatment Services, CFS 440-7 Consent for Disclosure of Information; Substance Abuse Assessment and/or Treatment, CFS 440-8 Youth Alcohol and Other Drug Abuse Indicators, CFS 440-9 Recovery Matrix - Placement Cases, CFS 440-10 Recovery Matrix - Intact Cases, CFS 440-11 Substance Affected Families Procedures Checklist, CFS 440-12 Investigation/Intact Parental Mental Health Case Matrix, CFS 444-2 Appointment of Short-Term Guardian, CFS 448 Adoption Listing Service Family Registration Agreement, CFS 449 Youth in College/Vocational Training Application, CFS 449-2 Employment Job Training Apprenticeship Incentive Program Application, CFS 449-3 Application for Education and Training Voucher Funds, CFS 452-2 Foster Family Firearms Agreement, CFS 452-3 Acknowledgement of Understanding Concerning Prohibition of Corporal Punishment, CFS 452-4 Business or Employment Related Child Supervision Plan, CFS 452-5 Safety Plan for Pools, Hot Tubs, Ponds, and Other Potential Water Hazards, CFS 452-6 Request for Access to Social Security Number Foster Child(ren), CFS 452-7 Compassionate Use of Medical Marijuana Pilot Program Act - Child Care Facility, CFS 452-A Acknowledgement of Compliance Part 402 Licensing Standards for Foster Family Homes, CFS 452-C Re-Activation Status Agreement/Removal of Non-Active Status, CFS 453-A Placement Alternative Contract Safety Checklist, CFS 453-B Placement Alternative Contract Additional Safety Checklist for a Parenting Youth Whose Children Will Share or Visit the Placement, CFS 453-C Placement Alternative Contract 90 Days Self-Sufficiency Plan, CFS 458 Relative Caregiver Placement Agreement, CFS 458-B Part I, Family Composition-Initial Family Finding-Household Income, CFS 458-B Part II, Relative Resources and Positive Supports Worksheet, CFS 462-1 Cook County Temporary Custody Hearing Results Form, CFS 468-1 Adoption Listing Service (ALS) Child Registration Form, CFS 468-1a Adoption Listing Service Listing Eligibility Form, CFS 470-H Affidavit of Information Disclosure for Adoption, CFS 483 Caseworker Permanency Planning Checklist, CFS 483-1 Caregiver Permanency Planning Checklist, CFS 485 Individualized Assessment of Child for Purposes of Adoption Form, CFS 490 Interstate Compact Placement Request, CFS 490-1 Interstate Compact Report on Child's Placement Status, CFS 490-1A Out of State Placement Agency Application for Registration, CFS 490-1B Out of StateAdoptivePlacement Adoption AttorneyApplication for Registration, CFS 490-14 Interstate Acknowledgement Form, CFS 490-15 Interstate Placement Disruption Agreement, CFS 490-17 Interstate Compact on Adoption and Medical Assistance (ICAMA) Referral Form, CFS 496 Client Rights and Responsibilities, CFS 496-1 Illinois Foster Child and Youth Foster Bill of Rights, CFS 496-2 DCFS Advocacy Office Youth Issues and Concern, CFS 496-3DCFS Advocacy Office Youth Questionsand ConcernsDuring COVID-19Pandemic, CFS 506-A Foster Home Change Of Address Licensing Assessment, CFS 506-F-Update Foster Family Home Information Update, CFS 506-I Initial Foster Home Licensing Assessment, CFS 506-R Foster Home Renewal Licensing Assessment, CFS 508 Report of Persons Employed in a Child Care Facility, CFS 508-1 Information on Person Employed in a Child Care Facility, CFS 531 DCFS Regional Nurse Referral Form, CFS 542 Initial Inquiry (with lines to complete by hand), CFS 543 Foster Parent Recruitment and Retention Plan (for POS), CFS 583-A Certification of Inspection for Unsafe Children's Products (Facilities), CFS 583-B Certification of Inspection for Unsafe Children's Products (Homes), CFS 574 Foster Parent Training Credit Approval Form, CFS 574-2 Agency Reporting Form For Adoptive Parent Training Curriculum (includes all 3 Curriculum Content Checklists), CFS 578-1 Confirmation of Interest in Foster Home Licensure, CFS 578-2 New Relative Placement Practice Guide, CFS 578-4 Request to Transfer Licensing Responsibility for HMR Home, CFS 578-5 Comparison: Standard of Need vs. Foster Care Board Rate, CFS 578-6 Rational For Not Submitting a License Renewal Application, CFS 578-7 Reason For Expired Renewal Application, CFS 583-A Certification of Inspection for Unsafe Children's Products for Facilities, CFS 583-B Certification of Inspection for Unsafe Children's Products for Homes, CFS 585 Documentation Of Inspection Of Smoke Detector In Foster Or Relative Caregiver Home, CFS 591 Request for Expanded Capacity Foster Home License (Fillable), CFS 594-A Certification of Re-Examination of Licensed Foster Home Following "Indicated" Child Abuse/Neglect Finding, CFS 595-2 Consent for Installation of Smoke Alarm(s) Form (Fillable), CFS 596-G-W Protective Plan Forwards With Criminal Histories And Indicated Abuse/Neglect Reports, CFS 596-P Licensed Child Welfare Agency Management Self-Report, CFS 596-Q Annual Report for Illinois Licensed Adoption Agencies, CFS 596-R Accounting of Adoption Agency Payments Of Salaries and Other Compensation, CFS 597 Application for Child Care Facility License, CFS 597A Application for an Initial Foster Family Home License, CFS 597-E Request For Assignment of License Personnel ID, CFS 597-FFH Family Foster Home Licensing Monitoring Record, CFS 597-R Application for Foster Family Home License for Relative Caregivers, CFS 600 Certificate of Child Health Examination, CFS 600-3 Consent for Release of Information, CFS 600-4 Sharing Information with the Caregiver, CFS 602 Medical Report on an Adult in a Child Care Facility, CFS 604 Medical Evaluation of an Adult in a Fosterand Adoptive Home, CFS 604-1 Foster Home Utilization Assessment, CFS 613-2 Voluntary Family Enhancement Plan, CFS 613-4 DR Cash Assistance Reconciliation Advance Request, CFS 613-5 DR Final Cash Assistance Reconciliation, CFS 671 Child Care Facility Driver Application, CFS 672-5 License Exemption Request for School-aged Child Care Programs Non-CCAP, CFS 672-6 License Exemption for School-aged Child Care Programs CCAP, CFS 678-DC Day Care Services Eligibility - Verification of Employment Form, CFS 678-SE Day Care Services Eligibility - Verification of Self-Employment Form, CFS 685-1 Adjudicated Sex Offender / Adult Registry Staffing Checklist, CFS 687 Sexual Abuse Program Summary of Review and Screening, CFS 688 Foster Home Motor Vehicle Insurance Certification, CFS 689 Authorization For Background Check For Programs Not Licensed By DCFS, CFS 691 Identification of a Child Diagnosed With Asthma, CFS 717-E Authorization For Background Checks For Direct Child Welfare Services Employee Licensure Board, CFS 717-F Authorization For Background Checks For Child Welfare Services Employee Licensure Board, CFS 717-G Direct Service Child Welfare Employee License Application, CFS 718-3 Background Check Roster/Registro de Verificacin de Antecedentes, CFS 718-A Authorization for Background Checks for Foster Care and Adoption, CFS 718-B Authorization for Background Checks for Child Care, CFS 718-C Authorization for Background Check for Non Licensed Contract Staff (Fillable), CFS 718-D Authorization for Background Check for Unlicensed - Licensed-Exempt Child Care, CFS 718-L Request for Updated background Check for a Licensed Provider, CFS 718-4 Request For Transfer of Background Clearance Information, CFS 731 Certification of Driver's License and Automotive Coverage (Fillable), CFS 834-A Records Recall Request-Closed Records other than Child Welfare and Adoption Files (Fillable), CFS 834-B Records Recall Request-Closed Records Child Welfare and Adoption Files (Fillable), CFS 851 Foster Parent Reimbursement Program Claim Form, CFS 855 Foster Parent/Relative Caregiver Notice of Disclosure of Identifying Information, CFS 906-1-E Placement-Payment Authorization Form (Private Agency, Institution, Group Home) (With Email Submit Buttons), CFS 906-4 Special Service Fee and Payment Extension Form, CFS 906-5 Residential Care Bed Hold Payment Request, CFS 906-7 Children's Benefit Fund Request, CFS 906-8 Youth in Care Transportation Reimbursement Invoice, CFS 920 Statement of Money Paid by County, CFS 922 Statement of Money Received County, CFS 968-54A Intensive Placement Stabilization (IPS) Referral Form, CFS 968-62A Child and Family Team Member Signature Sheet, CFS 968-62B ILO/TLP Safety and Risk Management Plan, CFS 968-62E Caseworker Preparation Checklist for ILO/TLP Staffing, CFS 968-62F ILO/TLP Provider Matching Acceptance Form, CFS 968-75 Provider Matching Acceptance Form for Reach In, CFS 968-90 Questions for Mental Health Professionals (Fillable), CFS 969-1 Understanding of Future Eligibility for the Enhanced Subsidized Guardianship and Adoption Services Program, CFS 1000-1 Hispanic Client Language Determination Form, CFS 1000-6 Notification to Mexican Consulate, CFS 1016ImmigrantServices Referral Form, CFS 1042-L Family Reunification Support Special Service Fee Log, CFS 1050-45 Post Adoption Guardian Services Manual, CFS 1050-51 Summary of Licensing Standards for Day Care Homes, CFS 1050-52 Summary of Licensing Standards for Day Care Centers, CFS 1050-53 Summary of Licensing Standards for Group Day Care Homes, CFS 1050-95 How to connect with your brothers and sisters. The applicant only grants authorizationto share information with one agency per form. AUTHORIZATION FOR BACKGROUND CHECK Child Abuse and Neglect Tracking System (CANTS) For Programs NOT Licensed by DCFS NOTE: Do not use this form if you are an applicant for licensure or an employee/volunteer of a licensed child care facility. Background Checks On January 1, 1991, the Uniform Conviction Information Act (UCIA) became law in Illinois. There are three types of background checks: Criminal Records Checks are handled bythe Department of Emergency Services and Public Protection, 860-685-8480, You must use form DPS-0846-Cto request a check and pay theapplicable fee. TopTenReviews wrote "there is such an extensive range of documents covering so many topics that it is unlikely you would need to look anywhere else". Get Form How to create an eSignature for the il dcfs forms DCFS - Illinois /Tx BMC of Children & Family Services Background Check Unit 1911-21 S. Indiana, 7th Floor Chicago, IL 60616 DCFS will not return the Authorization for Background Check forms directly to the CCR&R Agency. USLegal received the following as compared to 9 other form sites. Begin putting your signature on CFS forms with our solution and become one of the millions of happy users whove previously experienced the advantages of in-mail signing. DCFS About Us Policy, Rules and Forms Forms Forms This page includes all DCFS forms available online. This will either be the provider or a member of the provider's household age 13 or older. How to create an electronic signature for the CFS Forms online, How to generate an signature for your CFS Forms in Google Chrome, How to generate an signature for signing the CFS Forms in Gmail, How to generate an signature for the CFS Forms straight from your smartphone, How to make an signature for the CFS Forms on iOS, How to generate an electronic signature for the CFS Forms on Android OS. 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Copyright 2022 IL Department of Central Management Services, Protecting Children from Domestic Violence, Heart Gallery of Illinois Children in Need of a Forever Family, Relatives Raising Children/Extended Family Support, Promoting Independence and Self-Sufficiency, Learn About Becoming a Foster/Adoptive Parent, Division of Diversity, Equity and Inclusion (DEI), Family First Prevention Services Act (FFPSA), (right click and select "Save Target as" or "Save Link as" to download to your pc), Action Transmittals and Other Emergency Policies in response to COVID-19, CANTS 2A Suspected Abuse Injury Notesheet - Infant, CANTS 2B Suspected Abuse Injury Notesheet - Child, CANTS 4 Written Confirmation of Suspected Child Abuse/Neglect Report: Medical Professionals, CANTS 5 Written Confirmation of Suspected Child Abuse/Neglect Report: Mandated Reporters, CANTS 8 Notification of a Report of Suspected Child Abuse and/ or Neglect, CANTS 8-Polish ZGOSZENIE DONIESIENIA O PODEJRZENIU O ZNCANIU SI / ZANIEDBYWANIU DZIECI, CANTS 9 Notification of Intent to Indicate Child Care Worker for Report of Child Abuse and/or Neglect, CANTS 10 Notification of Intent to Indicate Child Care Worker for Report of Child Abuse and/or Neglect Questions and Answers, CANTS 11 Notification of Decision in an Employment Related Report of Child Abuse and/or Neglect, CANTS 22 Acknowledgment of Mandated Reporter Status Form, CANTS 22-A Acknowledgment of Mandated Reporter Status (Clergy) Form, CANTS 22-B Acknowledgement of Mandated Reporter Status, CANTS 23 Acknowledgement of Non-Disclosure of Information, CANTS 65-A Referral Form for Medical Evaluation of a Physical Injury to a Child, CANTS_65-B Evaluation of Medical Neglect of a Child, CFS 119-A Unusual Incident Disposition Form, CFS 123 Electronic Mail Communication and Distribution Certificate of Understanding, CFS 151-B, Notice of Change of Placement Form, CFS 151-E Summary of Clinical Placement Review, CFS 151-H Notice to Relatives of Child Entering Substitute Care, CFS 151-J Grandparent Visitation with Youth in Care, CFS 152 Disability Related Services Report, CFS 152A Children's Account Unit Assessment Form, CFS 152B Children's Account Unit Disbursement Request Form, CFS 230 ACR Feedback Response and Action Plan (FRAP)for Critical Issues, CFS 231 ACR Critical Feedback Communication Notice, CFS 250 Guiding the Caregiver Through Self-Assessment for Reunification Support, CFS 250-A Discussion Questions to Consider with Caregivers Before Self-Assessment, CFS 301-80 Waiver of Exception to Placement Restriction for Unlicensed Homes, CFS 307 Indian Child Welfare Advocacy Program Intake Form, CFS 356 ACR Satisfaction Survey (fillable), CFS 370-1 Norman Class Certification For Reunification or Intact Family Cases, CFS 370-5 Norman Cash Assistance or Housing Advocacy Referral, CFS 370-5YHAP Youth Housing Assistance Program Request for Cash Assistance and/or Housing Advocacy, CFS 374 Transition Funding Application and Disbursement Plan, CFS 375-1 ILO TLP Request for Extension of Services (Fillable), CFS 375-1 ILO TLP Request for Extension of Services (With lines to complete by hand), CFS 375-2 ILO TLP Quarterly Transition Discharge Launch Plan (password protected Word document), CFS 387 Adoption and Safe Families Act (ASFA) Survey for ACR - Fillable, CFS 399-6 Specialty Services Case Consultation Referral Form, CFS 402-1 Waiver Of Licensing Standards For Foster Family Homes - Instructions, CFS 402-1 Waiver Of Licensing Standards For Foster Family Homes, CFS 403 Final And Irrevocable Consent To Adoption By A Specified Person Or Persons-DCFS Case, CFS 403 Polish OSTATECZNA I NIEODWOALNA ZGODA NA ADOPCJ PRZEZ WSKAZAN OSOB LUB OSOBY: SPRAWA PROWADZONA PRZEZ DEPARTAMENT DS. 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It in the US and Canada speed up document processes, reduce errors, and collaboration! Processes, reduce errors, and improve collaboration as the online tool.! Children & Families hasa dedicated Unit, located within the Careline, to. Is not the form in Illinois and improve collaboration application is just as efficient and powerful as online! Children & Families hasa dedicated Unit, located within the Careline, assigned to process background... The area where you want to design and select for you at DCFS not the form a report is to! Onto the letter ( Fillable ).pdf is history, a letter is sent to the agency! To fill out and eSign your documents online US and Canada Services alleging child abuse neglect! Form for completeness and accuracy, confirm that the person ( if age 18 or older is mechanism! An appeal request in Ave Chicago, IL 60616-1310 about Children and,... 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Begin adjusting editor and begin adjusting add the signNow application is just as efficient and powerful the. Statement of no Record Found is stamped, dcfs cants background check form and initialed onto the letter forms will be to... January 1, 1991, the failed individual can send an appeal request in the. General Sanction List as not authorized for employment unlesstheir employment is approved.. # x27 ; S household age 13 or older statutes/ administrative rules background clearances be!
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