Authorization For Release Of Information For Registered Organizations

Download a blank fillable Authorization For Release Of Information For Registered Organizations in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Authorization For Release Of Information For Registered Organizations with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.


Division of Children and Family Services (CFS)
Nebraska Child Abuse and Neglect Central Registry (CAN Registry)/
Nebraska Adult Protective Services Central Registry (APS Registry)
Authorization for Release of Information for Registered Organizations
All designated fields must be completed or the request will be returned and not processed. Please type or print legibly. This form is for use
only by organizations who have registered with CFS to obtain CAN Registry and/or APS Registry information. For information on how
to register your organization go to: .
Registered Organization ID Number
Registered Organization Name
Nebraska 4-H Youth Development
Last Name
Date of Birth
Social Security Number
Current Address
Zip Code
Applicant's E-Mail Address (Please leave the E-Mail field blank if you prefer to receive correspondence by U.S. Mail).
Other names, such as a maiden name, former married name, or nickname, used in the past 20 years:
Names and birthdates of your children and children who lived with you:
All previous addresses at which you have resided in the past 20 years (minimum City & State):
Volunteer County ______________________
CFS-5 Rev. 12/15 (65655)


00 votes

Related Articles

Related forms

Related Categories

Parent category: Legal
Page of 2