Form 595-1396 - Dhs Criminal History Record Check Form B - State Of Iowa Page 2

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WAIVER:
Iowa law does not require waiver. However, without a waiver any arrest over 18 months old without a
disposition, cannot be given to a non-law enforcement agency.
Deferred judgments where DCI has received notice of successful completion of probation also cannot
be given out to non-law enforcement agencies without a signed waiver.
General Information:
The information requested is based on name and exact date of birth only. Without fingerprints a
positive identification cannot be assured. If a person disputes the accuracy of information maintained
by the Department, they may challenge the information by writing to the address on the front of this
form or personally appearing at DCI headquarters during normal working hours.
The records maintained by the Iowa Department of Public Safety are based upon reports from other
criminal justice agencies and therefore, the Department cannot guarantee the completeness of the
information provided.
The criminal history check is of the Iowa Central Repository only. No other state or federal agency
records can be searched under current law.
In Iowa, a deferred judgment is not considered a conviction once the defendant has been discharged
after successfully completing probation. However, it should be noted that a deferred judgment may
still be considered as an offense when considering charges for certain specified multiple offense
crimes, i.e., second offense OWI. If a disposition reflects that a deferred judgment was given, you may
want to inquire of the individual his or her current status.
Any questions in reference to Iowa criminal history records can be answered by writing to the address
on the front of this form or calling (515) 725-6066 between 8:00 a.m. and 4:30 p.m., Monday through
Friday.
If the “No CCH record found” box is checked, it could also mean that information in the file is not
releasable per Iowa law without a waiver.
Reminder:
Each agency, other than day care, should submit a self-addressed envelope with their requests.
This will expedite the process.
FORM B IS FOR THE SPECIFIC PURPOSE SET OUT ON THE FRONT. COURT
ORDERED HOME STUDY MUST SUBMIT FORM A WITH PAYMENT.
595-1396 (Rev. 8/07)
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