Worker Registration - Missouri Department Of Health And Senior Services Page 2
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1
2WHAT IS THE FAMILY CARE SAFETY REGISTRY?
The Family Care Safety Registry (FCSR), administered by the Missouri Department of Health and Senior Services (DHSS), provides families
and employers with a method to obtain background screening information. The Registry, through various state agencies, offers several
resources to screen child care, long term care and mental health workers:
•
State criminal history and sex offender registry records maintained by the Missouri State Highway Patrol
•
Child abuse/neglect records maintained by the Missouri Department of Social Services
•
The Employee Disqualification List maintained by the Missouri Department of Health and Senior Services
•
The Employee Disqualification Registry maintained by the Missouri Department of Mental Health
•
Child care facility licensing records maintained by the Missouri Department of Health and Senior Services
•
Foster parent records maintained by the Missouri Department of Social Services
WHO HAS TO REGISTER?
Any person hired on or after January 1, 2001, as a child care worker or elder care worker, hired on or after January 1, 2002, as a personal
care worker, or hired on or after January 1, 2009, as a mental health worker, as provided in §210.906, RSMo, is required to make application
for registration in the Family Care Safety Registry within fifteen (15) days of the beginning of employment. Such person who fails to
submit a completed registration form to the DHSS without good cause, as determined by the department, is guilty of a class B
misdemeanor. Employees and volunteers from non-state and/or federally regulated entities are NOT REQUIRED to register with the FCSR.
HOW DO I COMPLETE THE REGISTRATION FORM?
Registration Type – Check at least one box from the left column for type of registration that best describes your worker category. If no other
type applies, select “Voluntary.” (A "voluntary registrant" is a person who is not mandated to register with the Family Care Safety Registry
pursuant to §210.900 et seq., RSMo.) If you checked Long Term Care / Personal Care, please also make one or more selections from the
column on the right for subcategory.
Social Security Number – You must provide your Social Security number pursuant to 19CSR 30-80.030(1). This identifying information,
including Social Security number, will be used for internal identification purposes and to conduct background screenings for the resource
information listed in paragraph one above.
Personal Information – List your current Last Name, First Name, Middle Name, and any suffix associated with your last name. List any other
names by which you may have been known, including maiden names, past married names, and nicknames (attach additional sheets if
needed). For identification purposes, list your gender and date of birth.
Contact Information – List your address, city, state, ZIP code, and county. Include your telephone number and email address. We will use
this information to notify you of registration results and any background screenings conducted. Email notifications will be encrypted
for improved security. To reduce postage costs, the Registry may contact you to request a personal email address if one is not provided.
Employer Associated with this Registration - If you are currently employed by or are seeking employment with a child care or long term care
provider, please list the facility name, address, telephone number, and contact person. If registration is not for employment purposes,
make a selection from column on right. The employer entered in this section will not receive a copy of the registration notification.
Employers
eligible to use the Registry for caregiver screenings must make a separate request for your background information.
Registration Agreement – Sign and date the registration form. Your signature will authorize the Family Care Safety Registry to conduct the
background screening outlined in §210.903.2, RSMo and to provide the information to requesters for employment purposes, as provided in
§210.921.1, RSMo.
WHERE DO I SEND MY REGISTRATION FORM?
Send your completed registration form and photocopy of Social Security card and required fee to the Missouri Department of Health and
Senior Services, ATTN: Fee Receipts, P.O. Box 570, Jefferson City, MO 65102. If you have questions, please call the Registry using the
toll-free telephone number, 866-422-6872.
WHEN WILL I KNOW THE RESULTS OF MY BACKGROUND SCREENING?
After the background screening has been completed, you will be notified in writing of the results that will be recorded in the Family Care
Safety Registry. You will also be notified in writing each time background screening information is provided. The notification will contain the
name and address of the person who made the request and the background information disclosed. The person making the request will be
informed that information will be released for employment purposes only, pursuant to §210.921.1, RSMo. Any person using Registry
information for any other purpose is guilty of a class B misdemeanor. In addition, state agencies can request information for licensure or
regulatory purposes. Prior to disclosing information, the Registry obtains the name and address of the requester, and determines that the
request is for employment or regulatory purposes. To ensure you receive these notifications, it will be important for you to notify the Family
Care Safety Registry when you have a change in your contact information. Notify the Family Care Safety Registry of changes in personal or
contact information using the toll-free telephone number, 866-422-6872, by email to fcsr@health.mo.gov, or by mail to FCSR, PO Box 570,
Jefferson City, MO 65102.
WHAT IF I DON'T AGREE WITH THE RESULTS OF MY BACKGROUND SCREENING?
As provided in §210.912, RSMo, you have the right to appeal the information transferred to the Family Care Safety Registry. Your right to
appeal is limited to the accuracy of the transfer of information from the state agency that maintains the background information and does not
include a right to appeal the accuracy of the substance of the information transferred. An appeal must be filed in writing to the Office of the
Director, Missouri Department of Health and Senior Services, P.O. Box 570, Jefferson City, MO, 65102, within 30 days of receiving the
results of the background screening determination. An administrative appeal shall be set within 30 days of the filing of the appeal and a
decision shall be made within 60 days. This right to appeal is in addition to any other appeal rights granted by state law.
WHAT INFORMATION WILL BE DISCLOSED BY THE FAMILY CARE SAFETY REGISTRY?
Disclosure of background information on a person registered in the Family Care Safety Registry will be limited. If the person is registered, the
Registry worker will disclose whether the person's name is listed in any of the background checks pursuant to §210.903, subsection 2,
RSMo, and if so, which one(s). Specific information will be disclosed by the Registry pursuant to §210.921, subsection 1, subdivision (2).
MO 580-2421 (FP)
Rev. 09/16
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