PURPOSE: This rule establishes procedures for submitting completed applications for registration in the Family Care Safety Registry.

1. (1) Application for Registration.

   1. (A) The application for registration in the Family Care Safety Registry shall include the following:

      1. 1. A completed Child-Care and Elder-

Care Worker Registration Form, provided by the department, shall be typewritten or printed in ink. The application shall include the following:

1. A. Applicant’s valid Social Security

number;

1. B. Information on applicant’s right to

appeal the information contained in the registry pursuant to section 210.912, RSMo;

1. C. Signed consent of the applicant for

the background checks pursuant to section 210.906, RSMo;

1. D. Signed consent of the applicant for

the release of information contained in the background check for employment purposes only;

1. E. Worker category;
2. F. Applicant’s last name, first name,

middle name;

1. G. Prior names used by applicant;
2. H. Applicant’s home address;
3. I. Applicant’s current mailing

address, if different than home address;

1. J. Applicant’s county of residence;
2. K. Applicant’s date of birth;
3. L. Applicant’s gender;
4. M. Name, address and county of

applicant’s current employer (if applicable); and

1. N. Signature of the applicant and date

of signature, in ink, which certifies that all information in the registration form is complete and true to the best of the applicant’s knowledge;

1. 2. A photocopy of applicant’s Social

Security card; and

1. 3. A check or money order for the non-

refundable fee of five dollars ($5) made payable to the Missouri Department of Health.

1. (B) If the department receives an incomplete application, it will request the required information from the applicant before the application is processed. If the department does not receive the required information within sixty (60) days from the date of the certified mailing of the request, the application shall be void and another application shall be filed. If a subsequent application is filed, it shall be filed pursuant to 19 CSR 30- 80.030(1)(A)–(B).
2. (C) Applications for registration may be submitted to the Family Care Safety Registry by the individual applicant or their employer or prospective employer. An employer or prospective employer may submit completed registration forms using a batch processing form, provided by the department, that will also serve as a request for background screening information.
3. (D) A batch processing form, provided by the department, shall include the employer’s or prospective employer’s name and address, a listing of applicants for whom applications for registration are attached, and the employer’s or prospective employer’s signature that certifies the requested information is for employment purposes only and will not be used for any other purpose. Once the application process has been completed and background checks conducted the Family Care Safety Registry will notify the worker and the employer or prospective employer, whose name and signature appears on the batch processing form, of the results of the determination recorded on the registry.

AUTHORITY: sections 210.906 and 210.924, RSMo 2000.* Emergency rule filed Sept. 19, 2000, effective Jan. 1, 2001, expired June 29, 2001. Original rule filed March 30, 2001, effective Sept. 30, 2001. *Original authority: 210.906, RSMo 1999; 210.924, RSMo 1999.