Outline
The AN 048 Arizona form plays a crucial role in the adoption process, particularly concerning the safety and well-being of children. This form is essential for adoptive families seeking a clearance from the Child Protective Services (CPS) Central Registry. It ensures that all household members are screened for any history of prior reports, thereby safeguarding the interests of the child being adopted. Completing the form requires detailed information about the adoptive parents and any other adult household members, including their names, birthdates, Social Security numbers, and addresses. Furthermore, it mandates the inclusion of all children living in the household, whether biological or adopted. The information collected is strictly confidential and is only accessible to individuals authorized by state and federal law. After filling out the form, it must be mailed to the designated CPS address for processing. The form also includes a certification statement, where signatories affirm the accuracy of the information provided. This process not only protects children but also upholds the integrity of the adoption system in Arizona.
Sample - An 048 Arizona Form
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) BIRTHDATE
CHILD’S NAME (Last, First, Middle) BIRTHDATE
CHILD’S NAME (Last, First, Middle) BIRTHDATE
CHILD’S NAME (Last, First, Middle) BIRTHDATE
CHILD’S NAME (Last, First, Middle) 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
TO BE COMPLETED BY CPS PERSONNEL
Central Registry information checked
There were no substantiated reports. report(s) attached
NAME AND ADDRESS OF AGENCY TO RECEIVE INFORMATION FROM
CENTRAL REGISTRY (THIS BLOCK MUST BE COMPLETED)
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.
Form Information
| Fact Name | Fact Description |
|---|---|
| Form Purpose | This form is used for obtaining a records clearance from the Child Protective Services Central Registry for adoptive families. |
| Confidentiality | Child Protective Services records are confidential and can only be released to individuals permitted by Arizona state law (A.R.S. § 8-807) and federal law. |
| Household Members | The form must be completed for all household members, including adoptive parents and other adults residing in the home. |
| Information Required | Information required includes names, birthdates, Social Security numbers, and addresses of all household members. |
| Children's Information | Details about all children living in the household, including biological and adopted children, must be provided. |
| Signature Requirement | All adopting parents and adult household members must sign the form, certifying that the information provided is accurate. |
| Agency Involvement | The form is often submitted by an agency requesting Central Registry records clearance for the adoptive family. |
| Submission Address | The completed form must be mailed to the Arizona Department of Economic Security at the specified address in Phoenix. |
| ADA Compliance | The form includes a disclosure regarding the Americans with Disabilities Act, ensuring accommodations for individuals with disabilities. |
| Contact Information | For further assistance or to request the form in an alternative format, individuals can contact the provided phone number. |
Detailed Guide for Filling Out An 048 Arizona
Completing the AN 048 Arizona form is essential for ensuring that all household members are properly documented for the Child Protective Services Central Registry. This process involves providing accurate personal information for each individual in the household. After filling out the form, you will need to mail it to the specified address for processing.
- Begin by entering the Adoptive Father's Name in the designated space (Last, First, Middle).
- Fill in the Birthdate and Social Security Number for the adoptive father.
- List any Other Names Used by the adoptive father.
- Provide the Adoptive Father's Address (No., Street, City, State, ZIP).
- Next, enter the Adoptive Mother's Name (Last, First, Middle).
- Fill in the Birthdate and Social Security Number for the adoptive mother.
- List any Other Names Used by the adoptive mother, including maiden name and prior married names.
- Provide the Adoptive Mother's Address (No., Street, City, State, ZIP).
- For each Other Adult Household Member, repeat the following steps:
- Enter the member's Name (Last, First, Middle).
- Fill in the Birthdate and Social Security Number.
- List any Other Names Used, including maiden name and prior married names.
- Provide their Additional Address (No., Street, City, State, ZIP).
- List the Children’s Names (Include birth, adopted, and any other children living in the household).
- For each child, enter their Name (Last, First, Middle) and Birthdate.
- Certify the accuracy of the information by signing where indicated for the Adoptive Father, Adoptive Mother, and any Other Adult Household Members.
- Fill in the Name of Agency Requesting Central Registry Records Clearance and Area Code and Phone Number.
- Include the Date and the Case Manager's Signature.
- Provide the Name and Address of Agency to Receive Information.
- Leave the section for CPS Personnel to complete.
Obtain Answers on An 048 Arizona
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What is the purpose of the AN 048 Arizona form?
The AN 048 form is used to request a records clearance from the Child Protective Services (CPS) Central Registry in Arizona. This form must be completed for all adults living in the household of the adoptive family. The information collected is essential for checking any history of prior reports related to child welfare.
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Who needs to fill out the AN 048 form?
All adult household members, including the adoptive father and mother, must complete the AN 048 form. This includes providing personal details such as names, birthdates, Social Security numbers, and any other names used. It is crucial to ensure that all information is accurate and complete to avoid delays in the clearance process.
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How do I submit the AN 048 form?
Once you have filled out the form, you need to mail it to the address provided at the top of the document:
- Arizona Department of Economic Security
- Child Protective Services Central Registry
- P.O. Box 44240
- Phoenix, AZ 85064-4240
Make sure to send it as soon as possible to avoid any delays in your adoption process.
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What happens after I submit the AN 048 form?
After submission, CPS personnel will check the Central Registry for any substantiated reports related to the individuals listed on the form. You will receive a response indicating whether there were any reports or if everything is clear. This process is vital for ensuring the safety and well-being of children in adoptive families.
Common mistakes
Completing the AN 048 Arizona form is a crucial step in the adoption process, but many applicants make common mistakes that can delay their application. One frequent error is failing to include all household members on the form. The instructions clearly state that information is required for every adult and child living in the household. Omitting any member can lead to complications in the background check process.
Another common mistake involves incorrect or incomplete personal information. Applicants sometimes miswrite names, birthdates, or Social Security numbers. Such inaccuracies can result in significant delays as the authorities may need to verify the correct information before proceeding with the background check.
Some individuals neglect to provide all previous names used, particularly for adoptive mothers who may have maiden names or prior married names. This omission can hinder the thoroughness of the background check, as the agency may not be able to trace all relevant history without complete name information.
In addition, applicants often forget to sign the form. The certification section requires signatures from the adopting father, adopting mother, and any other adult household members. Without these signatures, the form is incomplete and cannot be processed.
Another mistake occurs when applicants fail to include the name of the agency requesting the records clearance. This information is vital for the agency to understand who is initiating the background check and for what purpose. Omitting it can cause unnecessary confusion and delays.
Moreover, some applicants do not provide a valid contact number. A working phone number is essential for any follow-up questions or clarifications that may arise during the review process. Without this information, communication becomes challenging.
Lastly, individuals may overlook the requirement to mail the completed form to the correct address. Sending it to an incorrect location can lead to further delays in the processing of the application. Ensuring that the form is sent to the specified address is a simple yet critical step in avoiding unnecessary complications.
Documents used along the form
The AN-048 form is a crucial document for prospective adoptive families in Arizona, used to check for any history of prior reports with the Child Protective Services Central Registry. Alongside this form, several other documents may be required to ensure a comprehensive review process. Below is a list of commonly used forms and documents that accompany the AN-048.
- ADOPTION APPLICATION: This document initiates the adoption process by collecting essential information about the adoptive parents and their intent to adopt. It includes personal details, reasons for adoption, and information about the child's background.
- HOME STUDY REPORT: Conducted by a licensed social worker, this report assesses the suitability of the adoptive home. It evaluates the family's environment, parenting capabilities, and overall readiness for adoption.
- BACKGROUND CHECK AUTHORIZATION: This form grants permission for authorities to conduct criminal background checks on all adult household members. It is a vital step to ensure the safety and well-being of the child.
- MEDICAL REPORTS: Adoptive parents may be required to submit medical evaluations that confirm their physical and mental health. These reports help assess the family's ability to provide a stable and nurturing environment for the child.
Completing the AN-048 form and these accompanying documents is essential for a successful adoption process. Each document plays a significant role in ensuring that the welfare of the child remains the top priority.
Similar forms
The AN-048 form serves as a crucial document in the adoption process in Arizona, particularly for obtaining a records clearance from the Child Protective Services Central Registry. Several other documents share similarities with the AN-048 form, each serving specific functions in the context of family and child welfare. Below are five documents that resemble the AN-048 form, along with explanations of their similarities.
- Child Abuse Central Registry Clearance Form: Like the AN-048, this form is used to request a background check on individuals to ensure they have no history of child abuse or neglect. Both documents require personal information about household members and are essential for safeguarding children.
- Adoption Application Form: This form is similar in that it collects detailed information about prospective adoptive parents and their household. Both forms aim to assess the suitability of individuals for adopting children, ensuring that all relevant background information is disclosed.
- Foster Care License Application: This application serves to evaluate individuals or families wishing to become foster parents. Like the AN-048, it requires personal details and background checks to protect children placed in foster care.
- Home Study Report: This document is often prepared by social workers to evaluate a family's readiness to adopt or foster. Similar to the AN-048, it involves thorough assessments of household members and aims to ensure a safe environment for children.
- Criminal Background Check Form: This form is used to conduct a criminal history check on individuals involved in the adoption process. Both the AN-048 and this form focus on ensuring that individuals with a history of criminal behavior are identified before children are placed in their care.
Dos and Don'ts
When filling out the AN-048 Arizona form, it's important to follow some guidelines to ensure your application is processed smoothly. Here are four things you should and shouldn't do:
- Do provide accurate information. Ensure that all names, addresses, and dates are correct.
- Do include all household members. This includes both adults and children living in the home.
- Don’t leave any sections blank. If a section does not apply, write "N/A" instead of leaving it empty.
- Don’t forget to sign the form. Both adoptive parents and any other adult household members must provide their signatures.
By following these guidelines, you can help ensure that your application is complete and ready for review. This will help speed up the process and reduce any potential delays.
Misconceptions
Understanding the AN 048 Arizona form can be challenging, especially with the many misconceptions surrounding it. Here are seven common misunderstandings:
- Only the adoptive parents need to fill out the form. This is not true. All adult household members must complete the form to ensure a thorough background check.
- The form is only for individuals who have previously adopted. In fact, this form is used for any household members of prospective adoptive families, regardless of prior adoption experience.
- Submitting the form guarantees approval for adoption. While the form is necessary for the background check, it does not guarantee that the adoption will be approved. Other factors are also considered during the adoption process.
- Information provided on the form is not confidential. On the contrary, the information is kept confidential and is only released to individuals permitted by state and federal law.
- The form can be submitted electronically. Currently, the form must be mailed to the specified address and cannot be submitted online.
- Only criminal history is checked. The background check includes a review of Child Protective Services records for any history of prior reports, not just criminal records.
- It’s okay to leave sections blank if they don’t apply. All sections of the form should be completed as fully as possible. Leaving sections blank may delay the processing of your request.
By understanding these misconceptions, individuals can better navigate the adoption process and ensure that they complete the AN 048 form correctly.
Key takeaways
When filling out the AN-048 Arizona form for Child Protective Services, keep these key points in mind:
- Complete for all household members: Ensure that the form includes information for every adult and child living in the home.
- Provide accurate information: Double-check all names, birthdates, and Social Security numbers for accuracy to avoid delays.
- Understand confidentiality: The information submitted is confidential and will only be released according to state and federal laws.
- Mail to the correct address: Send the completed form to the specified address in Phoenix, AZ, to ensure it is processed properly.
- Signatures are required: All adopting parents and adult household members must sign the form to certify the information is true.
- Be aware of ADA compliance: If you or someone in your household has a disability, notify the agency in advance for necessary accommodations.