Release Of Information Form printable pdf download

VA Department of Social Services

Central Registry Release of Information Form

Office of Background Investigations – Search Unit

801 East Main Street, 6

Floor, Richmond, VA 23219-2901

INSTRUCTIONS

Purpose

The Virginia Child Abuse and Neglect Central Registry is mandated by the Virginia Child Protective Law and contains the

names of individuals identified as an abuser or neglector in founded child abuse and/or neglect investigations conducted

in the state of Virginia. The findings are made by Child Protective Services staff in local departments of social services

and are maintained by the Virginia Department of Social Services. Legal mandates for the Virginia Department of Social

Services to provide a Central Registry and a mechanism for conducting searches of the registry are found in the Code of

VA 63.2-1515.

Read all instructions before completing the form:

1. Answer all questions completely and accurately by printing clearly in black ink or typing your answers. Failure

to complete or print clearly may delay or deny your request. Given the nature of the form and the actions to

be taken when received, the Office of Background Investigations shall not accept forms that have been

altered in any fashion. Forms that contain strike outs, correction tape or "white-out" will be returned.

2. If a middle name is an initial, indicate “initial only” otherwise, enter a full birth middle name.

3. If any answer is none, write “N/A“.

4. Sign in the presence of an official Notary Public. All request forms must be notarized. Only original signatures

will be accepted, no copies.

5. The correct fee must be mailed with your form. A payment of $7.00 per request, in the form of a money order,

company/business check, or cashier’s check will be accepted. If multiple requests are mailed together, payment

may be combined on one money order, company/business check, or cashier’s check. (ex. 5 requests at $7.00

each will total $35.00). A $50 fee will be charged for all returned checks.

Make payment payable to: Virginia Department of Social Services.

Personal checks and cash will not be accepted.

6. For agencies and facilities that require several searches per year, an agency code will be assigned to expedite

processing of the search requests.

7. If extra space is needed to complete the form (ie. providing information on addresses, spouses, and children),

attach an additional sheet along with your form to be mailed.

8. Search results disseminated beyond the requesting agency or individual are not considered official.

9. Mail your completed form and additional sheets (if used) to:

Virginia Department of Social Services

Office of Background Investigations - Search Unit

801 East Main Street, 6th Floor

Richmond, VA 23219-2901

032-02-0151-11-eng (02/14)

Release Of Information Form