1. a) The title, which will be: "Out-of-State Child Abuse and Neglect Findings Request".

2. b) Instructions for the form, which shall include the following text:

   1. c) A section entitled, "Section 1: Applicant Information", which requests the following information:
   2. 1) First name;
   3. 2) Middle name;
   4. 3) Last name;
   5. 4) Other names used including birth name and previously married name;
   6. 5) Date of birth;
   7. 6) Social security number or tax ID number (ITIN); and
   8. 7) Past addresses where the applicant has lived in the past 5 years.
   9. d) A section entitled "Section 2: Requesting Agency", which requests the following information:
   10. 1) Agency name;
   11. 2) Staff name;
   12. 3) Staff title;
   13. 4) Centralized email;
   14. 5) Staff phone number; and
   15. 6) Request date.

   "Use this form to check whether an individual has substantiated findings of child abuse or neglect in another state. This form must be completed if a relative caregiver applicant, or another adult living in their home, has lived out of state in the past five years. Complete one form for each individual for each state they have resided in."

3. e) A section entitled "Section 3: Results", which requests the following information:

   1. 1) Does the applicant have a record of substantiated child abuse or neglect and if so refers to an attached record.
   2. 2) Agency name;
   3. 3) Staff initials; and
   4. 4) Date.

A standardized form shall be used to check for child abuse and neglect findings in another state. Only a Department-issued official form with a CFS number in the top left-hand corner or a form issued and required by the receiving state shall satisfy the requirements of this Part. The Department form shall consist of the following elements: