N.H. Code Admin. R. Saf-C 5703.10 – Procedure for Any Person or Any Public or Private Agency to Request and Receive a Copy of the Criminal Conviction Record of Another

(a) To obtain a criminal conviction record of another, the requestor shall present a completed criminal conviction record release authorization form to the central repository, as specified in Saf-C 5703.11, in person or by mail.
(b) The criminal conviction record release authorization form utilized shall be as follows:
Table 5700-1 Criminal History Record Information Release Authorization Forms
Form Number
Title
How to Obtain:
DSSP 256
Criminal History Record Information Request Form
(eff. 7/15/16)
www.nh.gov/safety/nhsp
Department of Safety
Division of State Police – Criminal Records Unit
(603) 223-3867
33 Hazen Drive
Concord, NH 03305
DSSP 371
DHHS/DCYF Relative Criminal Check Only
(eff. 7/15/16)
www.dhhs.nh.gov Divisions/Offices; Division for Children, Youth and Families – Foster Care and Adoption (603) 271-4440 129 Pleasant Street, Concord, NH 03301
DSSP 372
License Exempt Child Care Form NH RSA 170-E:3-a
(eff. 10/1/16)
www.dhhs.nh.gov Divisions/Offices; Office of Operations Support – Child Care Licensing Unit (603) 271-9025 129 Pleasant Street, Concord, NH 03301
DSSP 373
Applicants to Practice Medicine NH RSA 329:11-a
(eff. 10/1/16)
www.oplc.nh.gov
Office of Professional Licensure and Certification – Division of Health Professionals (603) 271-4728, 121 South Fruit Street, Suite 301, Concord, NH 03301
DSSP 374
Applicants to Physician Assistants RSA 328-d:3-a
(eff. 10/1/16)
www.oplc.nh.gov
Office of Professional Licensure and Certification – Division of Health Professionals (603) 271-4728, 121 South Fruit Street, Suite 301, Concord, NH 03301
DSSP 375
BDS Area Agencies or Community Mental Health Centers
(eff. 7/15/16)
www.dhhs.nh.gov Divisions/Offices; Division of Community Based Care Services – Bureau of Behavioral Health (603) 271-5007 105 Pleasant Street, Concord, NH 03301
DSSP 376
TANF Requests for Child Care Form NH RSA 170-E:7, II
(eff. 7/15/16)
www.dhhs.nh.gov Divisions/Offices; Division of Family Assistance – Temporary Assistance for Needy Families (603) 271-9700 129 Pleasant Street, Concord, NH 03301
DSSP 377
New Applicant – Adoptive Parents Form NH RSA 170-B:18
(eff. 10/1/16)
www.dhhs.nh.gov Divisions/Offices; Division for Children, Youth and Families – Foster Care and Adoption (603) 271-4440 129 Pleasant Street, Concord, NH 03301
DSSP 378
Background Check Request of Alcohol and Other Drug Use Counselors NH RSA 330-C
(eff. 10/1/16)
www.oplc.nh.gov
Office of Professional Licensure and Certification – Division of Health Professionals (603) 271-6761, 121 South Fruit Street, Concord, NH 03301
DSSP 380
Driver Education Instructors NH RSA 263:44-b, II
(eff. 10/1/16)
www.nh.gov/safety/dmv
Department of Safety
Division of Motor Vehicles – Driver Education
(603) 227-4075
23 Hazen Drive
Concord, NH 03305
DSSP 381
Child Day Care NH RSA 170-E:7, II – Child Care Institutions RSA 170-E:29-a:II
(eff. 02/20/15)
www.dhhs.nh.gov Divisions/Offices; Office of Operations Support – Child Care Licensing Unit (603) 271-9025 129 Pleasant Street, Concord, NH 03301
Form Number
Title
How to Obtain:
DSSP 382
School Employee/Volunteer Criminal History Record Check RSA 189:13-a
(eff. 10/1/16)
www.nh.gov/safety/nhsp
Department of Safety
Division of State Police – Criminal Records Unit
(603) 223-3867
33 Hazen Drive
Concord, NH 03305
DSSP 383
County Employee Criminal History Background Check NH RSA 28:10-c (eff. 10/1/16)
www.nh.gov/government/local
Counties
Select Specific County
DSSP 384
DCYF Personnel
(eff. 7/15/16)
www.dhhs.nh.gov Divisions/Offices; Office of the Commissioner – Human Resources (603) 271-9344 129 Pleasant Street, Concord, NH 03301
DSSP 385
DHHS Area Agencies
(eff. 7/15/16)
www.dhhs.nh.gov Divisions/Offices; Division of Community Based Care Services – Bureau of Developmental Services (603) 271-5133, 105 Pleasant Street, Concord, NH 03301
DSSP 386
Department of Safety Employees NH RSA 21-P:15-c
(7/15/16)
www.nh.gov/government/state
Department of Safety
Division of Administration
(603) 223-8000
33 Hazen Drive
Concord, NH 03305
DSSP 387
Board of Nursing NH RSA 326-b:15
(eff. 10/1/16)
www.oplc.nh.gov
Office of Professional Licensure and Certification – Division of Health Professionals (603) 271-2323, 121 South Fruit Street, Concord, NH 03301
DSSP 388
Renewal – Foster Parents Form NH RSA 170-E:29
(eff. 7/15/16)
www.dhhs.nh.gov Divisions/Offices; Division for Children, Youth and Families – Foster Care and Adoption (603) 271-4440 129 Pleasant Street, Concord, NH 03301
DSSP 389
New Applicant – Foster Parents Form NH RSA 170-E:29
(eff. 7/15/16)
www.dhhs.nh.gov Divisions/Offices; Division for Children, Youth and Families – Foster Care and Adoption (603) 271-4440 129 Pleasant Street, Concord, NH 03301
DSSP 390
Hawkers, Peddlers, and Vendors Background Checks RSA 31:102-a & b
(eff. 10/1/16)
www.nh.gov/government/local
Select Specific Municipality
DSSP 391
Municipal Employee/Volunteer Candidate Background Checks NH RSA 41:9-b
(eff. 10/1/16)
www.nh.gov/government/local
Select Specific Municipality
DSSP 392
Licensing of Game Operators NH RSA 287-D:12
(eff. 10/1/16)
www.racing.nh.gov
(603)271-3391
14 Integra Drive, Concord, NH 03301
Form Number
Title
How to Obtain:
DSSP 393
Real Estate Appraisers Board NH RSA 310-B:6-a
(eff. 10/1/16)
www.oplc.nh.gov
Office of Professional Licensure and Certification – Division of Technical Professions (603) 271-2219, 121 South Fruit Street, Concord, NH 03301
DSSP 394
Serve America Act Employees or Volunteers
(eff. 10/1/16)
Provided to Applicant by Specific Employer
DSSP 406
Renewal – Adoptive Parents Form NH RSA 170-E:29
(eff. 7/15/16)
www.dhhs.nh.gov Divisions/Offices; Division for Children, Youth and Families – Foster Care and Adoption (603) 271-4440 129 Pleasant Street, Concord, NH 03301
DSSP 407
Child Day Care RSA 170-E:7, II–Child Care Institutions RSA 170-E:29-a, II
(eff. 7/15/16)
www.dhhs.nh.gov Divisions/Offices; Office of Operations Support – Child Care Licensing Unit (603) 271-9025 129 Pleasant Street, Concord, NH 03301
DSSP 408
Consumer Reporting Agency
(eff. 7/15/16)
Provided to Applicant by Specific Employer
DSSP 409
DCYF Intern/Volunteer Criminal Check Only
(eff. 7/15/16)
www.dhhs.nh.gov Divisions/Offices; Division for Children, Youth and Families – Foster Care and Adoption (603) 271-4440 129 Pleasant Street, Concord, NH 03301
DSSP 410
DHHS-DCYF Behavioral Health Provider
(eff. 7/15/16)
www.dhhs.nh.gov Divisions/Offices; Division of Community Based Care Services – Bureau of Behavioral Health (603) 271-5007 105 Pleasant Street, Concord, NH 03301
DSSP 411
DHHS Bureau of Behavioral Health
(eff. 7/15/16)
www.dhhs.nh.gov Divisions/Offices; Division of Community Based Care Services – Bureau of Behavioral Health (603) 271-5007 105 Pleasant Street, Concord, NH 03301
DSSP 412
Applicants for Initial Registration/Reinstatement as A Medical Technician RSA 328-I:7 (eff. 10/1/16)
www.oplc.nh.gov
Office of Professional Licensure and Certification – Division of Health Professionals (603) 271-8389, 121 South Fruit Street, Concord, NH 03301
DSSP 413
PL 108-79 Federal Prison Rape Elimination Act (PREA) [Contractor]
(eff. 7/15/16)
www.dhhs.nh.gov Divisions/Offices; Division for Children, Youth and Families – Foster Care and Adoption (603) 271-4440 129 Pleasant Street, Concord, NH 03301
DSSP 414
PL 108-79 Federal Prison Rape Elimination Act (PREA) [Staff]
(eff. 7/15/16)
www.dhhs.nh.gov Divisions/Offices; Division for Children, Youth and Families – Foster Care and Adoption (603) 271-4440 129 Pleasant Street, Concord, NH 03301
DSSP 415
Therapeutic Cannabis Program RSA 126-X:4, 8
(eff. 10/1/16)
www.dhhs.nh.gov Divisions/Offices; Office of Operations Support – Therapeutic Cannabis Program (603) 271-9234 129 Pleasant Street, Concord, NH 03301
DSSP 416
DHHS/DCYF Transportation and Child In Home Care
(eff. 7/15/16)
www.dhhs.nh.gov Divisions/Offices; Division for Children, Youth and Families – Child Development (603) 271-4242, 129 Pleasant Street, Concord, NH 03301
DSSP 417
New Hampshire Medicaid Program
(eff. 10/1/16)
www.dhhs.nh.gov Divisions/Offices; Office of Improvement and Integrity – Program Integrity Unit (603) 271-4344 129 Pleasant Street, Concord, NH 03301
Form Number
Title
How to Obtain:
DSSP 419
NH Banking Department/Banking Division
(eff. 10/1/16)
www.nh,gov/banking
(603) 271-3561
53 Regional Drive, Suite 200, Concord, NH 03301
DSSP 420
Nursing Home Administrators NH RSA 151-A:6-a
(eff. 10/1/16)
www.oplc.nh.gov
Office of Professional Licensure and Certification – Division of Health Professionals (603) 271-4728, 121 South Fruit Street, Suite 301, Concord, NH 03301
DSSP 421
Emergency Medical and Trauma Services
NH RSA 153-A:10-a
(eff. 10/1/16)
www.nh.gov/safety/fstems/ems
Department of Safety
Division of Fire Standards and Training- Bureau of Emergency Medical Services
(603) 223-4200
98 Smokey Bear Blvd
Concord, NH 03301
DSSP 422
NH Department of Revenue Employee Candidate Background Checks RSA 21-J:3-a (eff. 10/1/16)
www.revenue.nh.gov
(603) 230-5000
109 Pleasant Street, Concord, NH 03301
DSSP 424
New Hampshire Banking Department/Consumer Credit
(eff. 10/1/16)
www.nh,gov/banking
(603) 271-8675
53 Regional Drive, Suite 200, Concord, NH 03301
DSSP 425
Games of Chance Facility License NH RSA 287-D:8, VII
(eff. 10/1/16)
www.racing.nh.gov
(603)271-3391
14 Integra Drive, Concord, NH 03301
DSSP 426
NH Banking Department Employees RSA 383:7
(eff. 10/1/16)
www.nh,gov/banking
(603) 271-3561
53 Regional Drive, Suite 200, Concord, NH 03301
DSSP 427
Foster/Adoptive Adult Household Member Form NH RSA 170-E:29
(eff. 7/15/16)
www.dhhs.nh.gov Divisions/Offices; Division for Children, Youth and Families – Foster Care and Adoption (603) 271-4440 129 Pleasant Street, Concord, NH 03301
(c) In addition to the criminal conviction record release authorization form, $25.00 shall be included for the record check.
(d) On receipt of a completed criminal conviction record release authorization form and $25.00, a copy of the requested criminal conviction record shall be given or sent to the requestor.

Source. (See Revision Note at Chapter Heading for Saf-C 5700) #6704, eff 3-3-98; amd by #8173, eff 9-21-04; amd by #8591, INTERIM, eff 3-24-06, EXPIRES: 9-20-06; ss by #8651, eff 6-2-06; ss by #9329, eff 11-21-08, EXPIRED: 11-21-16 New. #12132, eff 3-17-17