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Get Md Dhr/ssa 1279a 2017-2026

7 edition) (All other versions are obsolete) . PART VI: BACKGROUND CLEARANCE FINDINGS (for Local Department or DHR use only) Applicant’s Name: MD CHESSIE ID#: 1. Active investigation 2. Sent to DHR or Local Department of Social Services: Name: Date: 3. We have determined that responsible for an is listed in the state’s database as being Indicated / investigation conducted in Unsubstantiated disposition of by Investigation #: Abuse / Neglect in reference to an . Child Protective S.

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How to fill out the MD DHR/SSA 1279A online

This guide provides comprehensive instructions on filling out the MD DHR/SSA 1279A form online. It aims to assist users in navigating each section of the form, ensuring that all necessary information is accurately provided.

Follow the steps to complete the MD DHR/SSA 1279A form online.

  1. Click the ‘Get Form’ button to obtain the form and open it in the editor.
  2. Begin by completing Part I, which covers the purpose of the search. Specify whether the release is to self or to an agency/individual and fill in the details relevant to the chosen option.
  3. In Part II, provide the search information for the individual whose name is being searched. Fill in the applicant’s last name, first name, social security number, date of birth, and other requested personal details.
  4. Detail any additional names used by the applicant and their current spouse's details. Document any children’s names, including adult children, and indicate if the applicant has lived or worked in Maryland in the past.
  5. Complete Part III by authorizing the Maryland Department of Human Resources to disclose the abuse or neglect findings. Double-check that all sections are complete.
  6. Review the form for completeness as instructed. After verifying all information, print the form before proceeding to Part IV.
  7. In Part IV, provide the required signature and date. If the applicant is under age 16, ensure a parent or guardian signs the form.
  8. Part V requires acknowledgment before a notary public. Complete this section as necessary.
  9. Once all parts are completed, save any changes and download or print the form as needed. Ensure to keep a copy for your records.

Complete the required documents online to ensure a smooth submission process.

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