endnote reference;}{\s18\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 \sbasedon0 \snext18 \slink19 \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; For federal Identity History Summary updates, the FBI must receive a request directly from the original arresting agency, from a court with control over the arrest data, or from another agency with control over the arrest data. Contact information for each state is provided on the State Identification Bureau listing. 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}. Section R432-35-4 - Covered Provider - DACS Process (1) Covered providers shall enter required information into DACS to initiate a clearance for each covered individual prior to issuance of a provisional license, license renewal or engagement as a covered individual. All Utahns should have fair and equitable opportunities to be healthy and safe. The applicant must also complete the Medical Cannabis Production Establishment Criminal Background Receipt form. This screening requires a separate application (see below). {\rtf1\adeflang1025\ansi\ansicpg1252\uc1\adeff5\deff0\stshfdbch31505\stshfloch31506\stshfhich31506\stshfbi31507\deflang1033\deflangfe1033\themelang1033\themelangfe0\themelangcs0{\fonttbl{\f0\fbidi \froman\fcharset0\fprq2{\*\panose 02020603050405020304}Times New Roman;} {\*\rsidtbl \rsid2757304\rsid7565795\rsid14438297}{\mmathPr\mmathFont34\mbrkBin0\mbrkBinSub0\msmallFrac0\mdispDef1\mlMargin0\mrMargin0\mdefJc1\mwrapIndent1440\mintLim0\mnaryLim1}{\info{\operator Michael Broschinsky}{\creatim\yr2020\mo4\dy22\hr14\min21} \pndec\pnstart1\pnindent720\pnhang {\pntxta . \par \tab \hich\af5\dbch\af31505\loch\f5 (c) view medical or financial records. Criminal Background Screening Published: Nov 30, 2022 Responsible Unit: Vice President for Human Resources 1. \par \tab \hich\af5\dbch\af31505\loch\f5 (a) means a hospital that is certified to provide long-term care services under the provisions of 42 U.S.C. \par \tab \hich\af5\dbch\af31505\loch\f5 (i) an aged individual, as defined by department rule; or The FBI is responsible for the storage of fingerprints and related Identity History Summary information for the nation and does not have the authority to modify any Identity History Summary information unless specifically notified to do so by the agency that owns the information. \hich\af5\dbch\af31505\loch\f5 n\hich\af5\dbch\af31505\loch\f5 existing license or deny licensure as a health care facility. \fs24\lang1033\langfe1033\loch\f5\hich\af5\dbch\af31505\cgrid\langnp1033\langfenp1033 \sbasedon0 \snext0 toc 1;}{\s22\ql \li720\ri720\sl240\slmult0\nowidctlpar\tqr\tldot\tx9360\wrapdefault\hyphpar0\faauto\rin720\lin720\itap0 \rtlch\fcs1 {\flomajor\f31500\fbidi \froman\fcharset0\fprq2{\*\panose 02020603050405020304}Times New Roman;}{\fdbmajor\f31501\fbidi \froman\fcharset0\fprq2{\*\panose 02020603050405020304}Times New Roman;} 534. Any adults over the age of 18 residing in the home must complete a background screening. \par \tab \hich\af5\dbch\af31505\loch\f5 (a) employment status; Salt Lake City, UT 84114-8280. Health, Family Health and Preparedness, Licensing Rule R432-35 Background Screening -- Health Facilities Notice of Proposed Rule (Amendment) DAR File No. \lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Table List 7;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Table List 8;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Table 3D effects 1;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Table 3D effects 2; \lsdpriority65 \lsdlocked0 Medium List 1;\lsdpriority66 \lsdlocked0 Medium List 2;\lsdpriority67 \lsdlocked0 Medium Grid 1;\lsdpriority68 \lsdlocked0 Medium Grid 2;\lsdpriority69 \lsdlocked0 Medium Grid 3;\lsdpriority70 \lsdlocked0 Dark List; Out-of-state applicants, or their employers, can call the Division of Criminal Investigation (DCI) to request a state only fingerprint kit to be mailed to them directly at 605. . 1cac24d91adc3d8d1797de195df3a708422c6cd795011744c0dd413db3e682c0655891c8caf8db294c79da356fa3740c65e388ae62945714339967709dca0b3a How do I Apply for a Concealed Firearm Permit? \lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Block Text;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Hyperlink;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 FollowedHyperlink;\lsdqformat1 \lsdpriority22 \lsdlocked0 Strong; d398af2571687c182716f094313a60dc6985876a2ec3ccb3751ab927e76b13f714a10bd7dc43945a5e1eaf579063894be530c616cd2714a5124538c5d253dfb1 {\fhimajor\f31502\fbidi \fswiss\fcharset0\fprq2{\*\panose 020f0302020204030204}Calibri Light;}{\fbimajor\f31503\fbidi \froman\fcharset0\fprq2{\*\panose 02020603050405020304}Times New Roman;} 1-855-323-DCFS(3237) \lsdpriority61 \lsdlocked0 Light List Accent 4;\lsdpriority62 \lsdlocked0 Light Grid Accent 4;\lsdpriority63 \lsdlocked0 Medium Shading 1 Accent 4;\lsdpriority64 \lsdlocked0 Medium Shading 2 Accent 4;\lsdpriority65 \lsdlocked0 Medium List 1 Accent 4; Please submit this form before having your fingerprinting and background check done at the Mississippi State Department of Health. Please be aware if the fingerprint authorization form is requested, the applicant has to wait for the Office to send the form with the fingerprint authorization before they can be live scanned. Crisis Line & Mobile Outreach Team 195 North 1950 West \par \tab \hich\af5\dbch\af31505\loch\f5 (ii) passage of time; 1-800-371-7897 \par \tab \hich\af5\dbch\af31505\loch\f5 (b) Submits fingerprints within 15 working days of engagement. \par \tab \hich\af5\dbch\af31505\loch\f5 (e) Patient family members; and 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 . \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: While it can be somewhat scary at first, it is actually a good thing. \par \tab \hich\af5\dbch\af31505\loch\f5 (b) which may include: Child Abuse/Neglect Online Background Check Authorization form for Applicants. \lsdqformat1 \lsdpriority31 \lsdlocked0 Subtle Reference;\lsdqformat1 \lsdpriority32 \lsdlocked0 Intense Reference;\lsdqformat1 \lsdpriority33 \lsdlocked0 Book Title;\lsdsemihidden1 \lsdunhideused1 \lsdpriority37 \lsdlocked0 Bibliography; ;}{\levelnumbers\'01;}\rtlch\fcs1 \af0 \ltrch\fcs0 \hres0\chhres0 }{\listlevel\levelnfc0\levelnfcn0\leveljc0 In the event that a new fingerprint based criminal offense is detected, OL will be alerted and will change the employment status to supervised only until the disposition is achieved. \hres0\chhres0 }{\listlevel\levelnfc4\levelnfcn4\leveljc0\leveljcn0\levelfollow2\levelstartat1\levelspace0\levelindent0{\leveltext\'02\'03. \par \tab \hich\af5\dbch\af31505\loch\f5 (c) as a volunteer; or used by Utah Department of Health (UDOH) to determine my eligibility for licensure as a medical cannabis product establishment owners or directors, or . Headquarters 000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000ffffffffffffffffffffffff000000000000000000000000000000000000000000000000 }{\rtlch\fcs1 \af5 \ltrch\fcs0 \expnd0\expndtw-3\insrsid14438297 Complete social security numbers are needed for all children ages 12 and over to track their screenings in DACS. I have read the attached Privacy Statement and understand my rights according to this statement. (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. \par \tab \hich\af5\dbch\af31505\loch\f5 (1) "Aged" means an individual who is 60 years of age or older. 195 North 1950 West }{\rtlch\fcs1 \af5 \ltrch\fcs0 \expnd0\expndtw-3\insrsid14438297 To challenge State of Utah criminal arrests and disposition data please complete the required application and submit to the Utah Bureau of Criminal Identification. \af5\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\loch\f5\hich\af5\dbch\af31505\cgrid\langnp1033\langfenp1033 \sbasedon0 \snext0 toc 7;}{\s28\ql \fi-720\li720\ri0\sl240\slmult0\nowidctlpar\tqr\tx9360\wrapdefault\hyphpar0\faauto\rin0\lin720\itap0 1-800-273-TALK(8255) 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. \par \tab \hich\af5\dbch\af31505\loch\f5 (4) A covered contractor may provisionally supply a covered individual to a covered provider while clearance is pendin\hich\af5\dbch\af31505\loch\f5 g. 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. be04197c6d1948eca6cc7b6d3343d49aa00c9819822ec3956e41c4727f29a28aab165b3be596f6a62ddd00dd91d5f42424fd6007b4d3fb84ffbbde073a8cb77f The following form is for those individuals seeking to obtain a copy of their own Utah criminal history record. A check or money order made payable to the "Utah Department of Health" may be . Utah Domestic Violence The needs of our communities continue to change as more and more people choose to make Utah their home. With the required release and proper payment, all adult arrest records are released. Sexual Violence Crisis Line \lsdsemihidden1 \lsdunhideused1 \lsdlocked0 List Bullet 4;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 List Bullet 5;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 List Number 2;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 List Number 3; \par }{\rtlch\fcs1 \ab\af5 \ltrch\fcs0 \b\expnd0\expndtw-3\insrsid14438297 \hich\af5\dbch\af31505\loch\f5 R432-35-2. Charges will be fairly assessed by the Office of Licensing as described in state law, A licensed program shall not be provided the details of any applicants screenings nor can they disclose screening results except as authorized by Utah or federal law. \par \tab \hich\af5\dbch\af31505\loch\f5 (iii) surrounding circumstances; {\flomajor\f31511\fbidi \froman\fcharset161\fprq2 Times New Roman Greek;}{\flomajor\f31512\fbidi \froman\fcharset162\fprq2 Times New Roman Tur;}{\flomajor\f31513\fbidi \froman\fcharset177\fprq2 Times New Roman (Hebrew);} \widowctrl\ftnbj\aenddoc\hyphhotz950\trackmoves0\trackformatting1\donotembedsysfont0\relyonvml0\donotembedlingdata1\grfdocevents0\validatexml0\showplaceholdtext0\ignoremixedcontent0\saveinvalidxml0\showxmlerrors0 Headquarters Multi-Agency State Office Building 195 North 1950 West Salt Lake City, Ut 84116. Utah Domestic Violence {\fdbmajor\f31522\fbidi \froman\fcharset162\fprq2 Times New Roman Tur;}{\fdbmajor\f31523\fbidi \froman\fcharset177\fprq2 Times New Roman (Hebrew);}{\fdbmajor\f31524\fbidi \froman\fcharset178\fprq2 Times New Roman (Arabic);} We have transtioned to DACS (Direct Access Clearance System), a completely online background screening system. PRIVACY POLICY ACKNOWLEDGEMENT FORM. NICS Process. {\*\cs10 \additive Default Paragraph Font;}{\*\ts11\tsrowd\trftsWidthB3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\trcbpat1\trcfpat1\tblind0\tblindtype3\tsvertalt\tsbrdrt\tsbrdrl\tsbrdrb\tsbrdrr\tsbrdrdgl\tsbrdrdgr\tsbrdrh\tsbrdrv \lsdpriority71 \lsdlocked0 Colorful Shading;\lsdpriority72 \lsdlocked0 Colorful List;\lsdpriority73 \lsdlocked0 Colorful Grid;\lsdpriority60 \lsdlocked0 Light Shading Accent 1;\lsdpriority61 \lsdlocked0 Light List Accent 1; \par }{\rtlch\fcs1 \ab\af5 \ltrch\fcs0 \b\expnd0\expndtw-3\insrsid14438297 \hich\af5\dbch\af31505\loch\f5 R432-35-1. d0cf11e0a1b11ae1000000000000000000000000000000003e000300feff090006000000000000000000000001000000010000000000000000100000feffffff00000000feffffff0000000000000000ffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffff 1-800-273-TALK(8255) Receiving Results: Once the Office reviews this information a determination will be made per 62A-2-120 and emailed from the Office to the email address provided from the non-licensed entity on the Background Screening Application. 000000300100005f72656c732f2e72656c73504b01022d00140006000800000021006b799616830000008a0000001c0000000000000000000000000019020000 Application to Become a Qualified Entity for Background Checks on Employees or Volunteers Download Utah Consent to Background Check Form Download Child Abuse/Neglect {\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;} To schedule an appointment, please click here. \lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Table Colorful 3;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Table Columns 1;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Table Columns 2;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Table Columns 3; \par \tab \hich\af5\dbch\af31505\loch\f5 (a) Signs a criminal background screening authorization form which\hich\af5\dbch\af31505\loch\f5 must be available for review by the department; and Salt Lake City, Ut 84116, DLBC Contact Info The top portion needs to be signed by the applicant, the bottom portion is signed by the non-licensed entity. \par \tab \hich\af5\dbch\af31505\loch\f5 (vii) dietary and food service staff; \par Headquarters \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 \lsdpriority47 \lsdlocked0 Grid Table 2 Accent 4;\lsdpriority48 \lsdlocked0 Grid Table 3 Accent 4;\lsdpriority49 \lsdlocked0 Grid Table 4 Accent 4;\lsdpriority50 \lsdlocked0 Grid Table 5 Dark Accent 4; Utah Department of Health and Human Services is now one agency. \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 : \lsdpriority67 \lsdlocked0 Medium Grid 1 Accent 5;\lsdpriority68 \lsdlocked0 Medium Grid 2 Accent 5;\lsdpriority69 \lsdlocked0 Medium Grid 3 Accent 5;\lsdpriority70 \lsdlocked0 Dark List Accent 5;\lsdpriority71 \lsdlocked0 Colorful Shading Accent 5; Follow the instructions on page 2 of the form for submitting the form and the payment information. \par \tab \hich\af5\dbch\af31505\loch\f5 (B) 76-5 Offenses Against the Person; ividual disagrees with the information provided, the individual may challenge the information through the appropriate agency. The screened professions listed below require background screening at initial licensure and/or renewal of licensure. \lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Table 3D effects 3;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Table Contemporary;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Table Elegant;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Table Professional; \par \tab \hich\af5\dbch\af31505\loch\f5 (d) a home health agency; or 6e22206267313d226c743122207478313d22646b3122206267323d226c743222207478323d22646b322220616363656e74313d22616363656e74312220616363 f9c6b10f3e4ebfe3566c25ab6b763a8792c9f14e7f7308b7dbd50c195f904fbfa919a175fa04431dd9cf58b73dcd6d4fe3ffdff73487f6f36d2773a8dfb8ed64 \par form on regular paper. \par }{\rtlch\fcs1 \ab\af5 \ltrch\fcs0 \b\expnd0\expndtw-3\insrsid14438297 \hich\af5\dbch\af31505\loch\f5 R432-35-10. \lsdpriority52 \lsdlocked0 Grid Table 7 Colorful Accent 5;\lsdpriority46 \lsdlocked0 Grid Table 1 Light Accent 6;\lsdpriority47 \lsdlocked0 Grid Table 2 Accent 6;\lsdpriority48 \lsdlocked0 Grid Table 3 Accent 6; Steps for Entering a Youth Application in DACS, Exemption Declaration (adult substance abuse treatment programs only), Contact Information for obtaining an out of state Central or Child Abuse Registry Check, I understand that my personal information including name, date of birth, social security number and fingerprints will be used for the purpose of conducting a criminal history records search through any applicable state and federal databases. \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 Screening applications typically take three weeks to process. rect Access Clearance System to initiate a clearance for each covered individual prior to being supplied by contract to a covered provider. One-time adoptions submitted by a non-licensed entity (adoption attorney, etc.) 1-888-421-1100 The FBI may retain your fingerprints and associated information/biometrics in NGI after the completion of this application and, while retained, your fingerprints may continue to be compared against other fingerprints submitted to or retained by NGI. 195 North 1950 West {\fbiminor\f31578\fbidi \froman\fcharset238\fprq2 Times New Roman CE;}{\fbiminor\f31579\fbidi \froman\fcharset204\fprq2 Times New Roman Cyr;}{\fbiminor\f31581\fbidi \froman\fcharset161\fprq2 Times New Roman Greek;} \par \tab \hich\af5\dbch\af31505\loch\f5 (b) a small health care facility; Record updates are made at the state level only, so the FBI cannot change its records. \lsdpriority67 \lsdlocked0 Medium Grid 1 Accent 6;\lsdpriority68 \lsdlocked0 Medium Grid 2 Accent 6;\lsdpriority69 \lsdlocked0 Medium Grid 3 Accent 6;\lsdpriority70 \lsdlocked0 Dark List Accent 6;\lsdpriority71 \lsdlocked0 Colorful Shading Accent 6; Salt Lake City, Ut 84116, DLBC Contact Info 617020786d6c6e733a613d22687474703a2f2f736368656d61732e6f70656e786d6c666f726d6174732e6f72672f64726177696e676d6c2f323030362f6d6169 \par }}{\*\aftnsep \ltrpar \pard\plain \ltrpar\ql \li0\ri0\sl-20\slmult0\nowidctlpar\wrapdefault\faauto\rin0\lin0\itap0 \rtlch\fcs1 \af5\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\loch\af5\hich\af5\dbch\af31505\cgrid\langnp1033\langfenp1033 { \par \tab \hich\af5\dbch\af31505\loch\f5 (5) "Cove\hich\af5\dbch\af31505\loch\f5 red contractor" means a person or corporation that supplies covered individuals, by contract, to: 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). ffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffff Background Screening. 1-800-273-TALK(8255) \fs24\lang1033\langfe1033\loch\f5\hich\af5\dbch\af31505\cgrid\langnp1033\langfenp1033 \sbasedon0 \snext0 toc 5;}{\s26\ql \fi-720\li720\ri0\sl240\slmult0\nowidctlpar\tqr\tx9360\wrapdefault\hyphpar0\faauto\rin0\lin720\itap0 \rtlch\fcs1 \af5\afs24\alang1025 02000000180000004d73786d6c322e534158584d4c5265616465722e362e3000000000000000000000060000 Rule R380-300. e Department determines an individual is not eligible for direct patient access based upon the criminal background screening and the individual disagrees with the information provided by the Criminal Investigations and Technical Services Division or court st enter required information into the Direct Access Clearance System to initiate and obtain a clearance for all individuals 12 years of age and older, who are not residents, and reside in the residential setting. submit live scan fingerprints. \par }{\rtlch\fcs1 \ab\af5 \ltrch\fcs0 \b\expnd0\expndtw-3\insrsid14438297 \hich\af5\dbch\af31505\loch\f5 R432-35. Prints will remain active for 60 days to allow for re-employment in a licensed setting. \par \tab \hich\af5\dbch\af31505\loch\f5 (i) the List of Excluded Individuals and Entities database maintained by the United States Department of Health and Human Services' Office of Inspector General.

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