Get Adult Abuse, Neglect, Exploitation Central Registry Release Of Information - Dcf Ks

Completing the Adult Abuse, Neglect, Exploitation Central Registry Release Of Information form is crucial for users requesting their information. This guide provides clear steps to assist users in filling out the form accurately and efficiently online.

Follow the steps to successfully complete the form.

1. Click the ‘Get Form’ button to obtain the form and open it in the online editor.
2. In the first section, print your full name clearly in the designated field where it states ‘I, (PRINT ONLY)’.
3. Provide the contact person's name along with their phone number in the specified fields for agency communication.
4. Fill in the agency name and mailing address accurately. If the agency is a Community Developmental Disability Organization, Community Mental Health Center, or Independent Living Resource Center, check the appropriate box.
5. Print any maiden name or other names you are known by in the designated field.
6. In the address section, enter your street address, city, state, and zip code, ensuring all details are correct.
7. Indicate your date of birth in the mm/dd/yyyy format in the appropriate box.
8. Provide your Social Security number in the designated field using the correct format.
9. Select your sex by circling either ‘M’ for male or ‘F’ for female.
10. Confirm your understanding of the privacy of the released information by reading the consent statement. Indicate whether you give permission for annual information release while associated with the agency by marking ‘Yes’ or ‘No’.
11. Sign and date the form using the mm/dd/yyyy format. Ensure your signature is clear.
12. Upon completing the form, save your changes. You can then download, print, or share the form as needed.

Complete your documents online today for a seamless experience.