Get Nh Dhhs 3655 2020-2025

The NH DHHS 3655 is an essential form used for consent to release adult abuse, neglect, and/or exploitation records. Completing this form accurately online is crucial for proper processing.

Follow the steps to successfully complete the NH DHHS 3655 online.

1. Press the ‘Get Form’ button to access the NH DHHS 3655, ensuring you can complete it online.
2. Begin by entering the employer information. Clearly fill out the employer name, mailing address, city/state/zip, telephone number, and fax number, as this section is mandatory for processing.
3. Next, proceed to the employee information section. Use clear block letters to print the last name, first name, and middle initial. Ensure all details are legible to avoid being stamped ‘Unable to Process’.
4. Complete the mailing address along with the city/state/zip and telephone number. Also indicate the gender by checking the appropriate box.
5. If you have any other names, such as a maiden name, provide them clearly in the designated sections.
6. Enter your date of birth accurately in the format of month, day, and year, as this information is required for processing.
7. Indicate your position by selecting one option: Employee, Consultant, or Volunteer. This will help clarify your relationship to the requesting employer.
8. You have the option to provide your Social Security number, which is optional but can assist with accurate identification.
9. Select the appropriate radio button for your application status: Applying, Current Position, or Other, and provide any necessary details.
10. Review the declaration regarding the use of the information disclosed, ensuring you understand how it will be applied by your employer.
11. Finally, provide your signature and the date, along with a witness signature, if required. Make sure both signatures are in place before submission.
12. After completing the form, you can save your changes, download, print, or share the NH DHHS 3655 form as needed.

Complete your NH DHHS 3655 form online today to ensure timely processing.