Free An 048 Arizona Form Get Form Now

Free An 048 Arizona Form

The An 048 Arizona form is a document used by the Arizona Department of Economic Security to conduct a records clearance for adoptive families. This form is essential for checking the Child Protective Services Central Registry for any history of prior reports involving household members. Completing this form ensures that all necessary information is gathered to maintain the safety and well-being of children in adoptive homes.

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Dos and Don'ts

When filling out the AN-048 Arizona form, it is essential to follow certain guidelines to ensure accuracy and compliance. Here are five things you should do and five things you should avoid:

  • Do provide complete information. Fill out all sections of the form, including names, addresses, and social security numbers for all household members.
  • Do double-check for accuracy. Review the information entered to ensure there are no errors or omissions.
  • Do sign and date the form. Ensure that all required signatures are provided, including those of the adopting parents and other adult household members.
  • Do mail the form to the correct address. Send the completed form to the address specified at the top of the document.
  • Do keep a copy for your records. Retain a copy of the completed form for your personal documentation.
  • Don't leave any sections blank. Incomplete forms may delay the processing of your request.
  • Don't use nicknames. Always provide legal names as they appear on official documents.
  • Don't forget to include all household members. Ensure that all adults and children living in the household are listed.
  • Don't submit the form without proper signatures. Missing signatures will result in rejection of the application.
  • Don't forget to check for deadlines. Be aware of any time-sensitive requirements related to the submission of this form.

Key takeaways

When filling out the AN-048 Arizona form for Child Protective Services Central Registry Records Clearance, consider the following key takeaways:

  • Confidentiality: The information provided on this form is confidential and only accessible to individuals authorized by state and federal law.
  • Household Members: Complete the form for all household members, including adoptive parents and other adults living in the home.
  • Accurate Information: Ensure that all details, such as names, birthdates, and Social Security numbers, are accurate and up-to-date.
  • Signature Requirement: The adopting father, adopting mother, and any other adult household members must sign the form to certify the information is true.
  • Mailing Instructions: Send the completed form to the designated address provided on the form for processing.
  • Agency Information: Include the name of the agency requesting the records clearance and ensure the agency’s contact information is correct.
  • ADA Compliance: Be aware of the Americans with Disabilities Act provisions that may require accommodations for individuals with disabilities during the process.

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What is the purpose of the AN 048 form?

The AN 048 form is used to request a records clearance from the Arizona Child Protective Services (CPS) Central Registry. It is required for all household members of an adoptive family to check for any history of prior reports related to child welfare.

Who needs to complete the AN 048 form?

All adult household members must complete the AN 048 form. This includes the adoptive father, adoptive mother, and any other adults living in the household. Additionally, the form must include information about any children in the household, whether they are biological, adopted, or otherwise.

How is the information on the form used?

The information provided on the AN 048 form is used to check the CPS Central Registry for any prior reports or substantiated findings related to child abuse or neglect. This process helps ensure the safety and well-being of children in the adoptive home.

Where should the completed form be sent?

Once completed, the AN 048 form should be mailed to the Arizona Department of Economic Security at the following address: P.O. Box 44240, Phoenix, AZ 85064-4240.

What happens after the form is submitted?

After submission, CPS personnel will review the information provided and check the Central Registry. They will then determine if there are any substantiated reports. You will receive a response indicating whether there are any findings.

Is the information on the AN 048 form confidential?

Yes, the information provided on the AN 048 form is confidential. It can only be released to individuals authorized by state and federal law, ensuring the privacy of all household members.

What should I do if I have a disability and need assistance with the form?

If you have a disability and require assistance, you should inform the Department of your needs in advance, if possible. They can provide accommodations, such as sign language interpreters or alternative formats of the document.

What if I find errors in the information provided on the form?

If you discover any errors after submitting the AN 048 form, contact the Arizona Department of Economic Security as soon as possible. It is important to ensure that all information is accurate to avoid delays in processing your records clearance.

How can I request additional information about the AN 048 form?

For more information about the AN 048 form or the records clearance process, you can contact the Arizona Department of Economic Security at (602) 542-3598. For TTY/TTD services, dial 7-1-1.

Documents used along the form

When navigating the adoption process in Arizona, the AN 048 form is a crucial document for obtaining a Child Protective Services (CPS) Central Registry Records Clearance. However, several other forms and documents are often required alongside it to ensure a smooth and compliant adoption process. Below is a list of commonly used documents that may accompany the AN 048 form.

  • ADOPTION APPLICATION: This document formally initiates the adoption process. It provides essential details about the adopting parents and the child, including personal information and the reason for adoption.
  • HOME STUDY REPORT: A comprehensive evaluation conducted by a licensed social worker. It assesses the suitability of the adopting family and includes interviews, background checks, and home visits.
  • BACKGROUND CHECKS: These are conducted on all adult household members to ensure there are no criminal records that could impact the adoption. This may include fingerprinting and checks against state and federal databases.
  • MEDICAL REPORTS: Health assessments of the adopting parents are often required. These reports confirm that the parents are physically and mentally fit to provide a stable environment for the child.
  • FINANCIAL STATEMENTS: Documentation showing the financial stability of the adopting family. This may include income statements, tax returns, and proof of employment.
  • REFERENCES: Personal and professional references may be required to support the adoption application. These individuals can provide insights into the adopting parents' character and parenting capabilities.
  • CONSENT FOR ADOPTION: If the child being adopted is older, their consent may be necessary. This document confirms that the child agrees to the adoption and understands its implications.
  • ADOPTION PLACEMENT AGREEMENT: This agreement outlines the terms and conditions under which the child will be placed with the adopting family. It includes details about the transition period and any support services available.

Understanding these documents and their purposes can significantly ease the adoption process. Each plays a vital role in ensuring that the adoption is in the best interest of the child and that all legal requirements are met. Being prepared with these forms can help foster a smoother experience for everyone involved.

Document Sample

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.

Guidelines on How to Fill Out An 048 Arizona

Filling out the AN 048 form is an important step in the process of obtaining a records clearance from the Arizona Child Protective Services. Follow these steps carefully to ensure that all necessary information is provided accurately.

  1. Begin by writing the adoptive father’s full name, including last, first, and middle names.
  2. Enter the adoptive father’s birthdate.
  3. Provide the adoptive father’s Social Security number.
  4. List any other names the adoptive father has used.
  5. Fill in the adoptive father’s complete address, including number, street, city, state, and ZIP code.
  6. Next, write the adoptive mother’s full name, including last, first, and middle names.
  7. Enter the adoptive mother’s birthdate.
  8. Provide the adoptive mother’s Social Security number.
  9. List any other names the adoptive mother has used, including maiden and prior married names.
  10. Fill in the adoptive mother’s complete address, including number, street, city, state, and ZIP code.
  11. For other adult household members, write the first adult’s full name, including last, first, and middle names.
  12. Enter the first adult’s birthdate.
  13. Provide the first adult’s Social Security number.
  14. List any other names this adult has used, including maiden and prior married names.
  15. Fill in the additional address for this adult, if applicable.
  16. Repeat the previous four steps for any additional adult household members.
  17. Now, list the names of all children living in the household, including birth, adopted, and any other children.
  18. For each child, provide their full name and birthdate.
  19. Certify that all information provided is true and accurate by signing the form in the designated areas for the adoptive father, adoptive mother, and any other adult household members.
  20. Include the date next to each signature.
  21. Write the name of the agency requesting the records clearance and include a contact phone number.
  22. Have the case manager sign and date the form.
  23. Finally, include the name and address of the agency that will receive the information.

Once you have completed the form, make sure to double-check all the information for accuracy. After verifying everything, mail the form to the address provided at the top. This will initiate the process for your records clearance.

Common mistakes

Filling out the AN-048 Arizona form can be a straightforward process, but many individuals make common mistakes that can delay their application. One frequent error is failing to include all household members. The form requires information for every adult living in the home, yet some applicants mistakenly only list themselves and their partner. This omission can lead to processing delays or even rejection of the application.

Another common mistake involves inaccuracies in names. It is essential to provide the full legal names of all individuals, including any other names used. Applicants often forget to include maiden names or previous married names for the adoptive mother, which can create confusion during the background check process. Ensuring that all names are accurately recorded is crucial.

People also tend to overlook the importance of providing complete addresses. Each household member’s address must be filled out completely, including the street number, city, state, and ZIP code. Missing or incorrect address information can hinder the ability of Child Protective Services to conduct a thorough background check.

Another mistake is not including Social Security numbers. The form explicitly requests this information for each adult household member. Some applicants might skip this section due to privacy concerns, but omitting the Social Security number can significantly delay the clearance process.

Additionally, applicants sometimes fail to sign the form. The certification statement at the bottom requires signatures from the adopting father, mother, and any other adult household members. Without these signatures, the form is incomplete and cannot be processed.

People may also neglect to double-check the birthdates provided. Incorrect birthdates can lead to mismatches during the verification process. It is advisable to verify this information against official documents to ensure accuracy.

Another frequent oversight is not providing a contact phone number. The agency may need to reach out for clarification or additional information. Without a valid phone number, communication can become challenging, resulting in unnecessary delays.

Lastly, many individuals fail to read the instructions carefully. The form contains important details regarding how to complete it properly. Taking the time to review the instructions can help prevent many of the aforementioned mistakes, ensuring a smoother application process.