New York State Justice Center for the Protection of People with Special Needs (Justice Center) Criminal Background Check Unit Request for Criminal History Record Check This form is for ODD providers.
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How to fill out the NY JC CBC 5 online
The NY JC CBC 5 form is essential for OPWDD providers in requesting a criminal history record check for applicants. This guide will provide a step-by-step approach to help users complete the form accurately and efficiently online.
Follow the steps to complete the NY JC CBC 5 form online.
- Click the ‘Get Form’ button to access the NY JC CBC 5 form and open it in your preferred editor.
- Fill in the agency, DDSO, or registered provider name along with the five-digit ID number in the designated fields.
- Indicate the type of check by selecting one of the following options: DDSO, voluntary provider, or registered provider.
- Provide the applicant's last name, first name, middle initial, date of birth, and social security number in the respective fields.
- Enter the applicant's street address or P.O. box, city, state, and zip code to ensure accurate identification.
- Select the applicant's status by checking one of the following boxes: Employee (non-state), Volunteer, Family Care Provider, or Employees of vendors and contractors.
- For voluntary agencies, enter the program type code from the provided list. For registered providers, select the appropriate four-digit code from page 2.
- Confirm that the applicant will have regular and substantial contact with individuals receiving services, and ensure informed consent is on file.
- Fill in the name and email of the authorized person, ensuring they sign and date the form.
- Once all fields are completed, save your changes, and you may choose to download, print, or share the form based on your needs.
Complete your NY JC CBC 5 form online today for a seamless submission process.
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