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Overview

The AN-048 Arizona form plays a crucial role for those undergoing the adoption process, serving as a bridge between prospective adoptive families and the Arizona Department of Economic Security's Child Protective Services Central Registry. This form, designed to uphold the confidentiality and integrity of CPS records, mandates completion by all members of a household joining the adoptive family. Its primary purpose is to facilitate a comprehensive check within the Child Protective Services Central Registry for any history of prior reports that could impact the safety and wellbeing of the child or children being adopted. Prospective adoptive parents along with any other adult household members are required to provide detailed personal information, including names, addresses, Social Security numbers, and dates of birth, as well as the names and birthdates of all children residing in the household. By requiring this information, the form seeks to ensure that adoptive and foster placements are made in the best interest of the child, promoting a safe and supportive family environment. The completion and submission of this form, as directed to the specified mailing address, is a significant step in the adoption process, illustrating a commitment to comply with state (A.R.S. § 8-807) and federal law regarding the protection of children's welfare. Additionally, it underscores the adoptive family’s responsibility to provide a truthful account of their background, supporting the overarching aim of the Child Protective Services to safeguard the interests and rights of children across Arizona.

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AN-048 (6-06)

ARIZONA DEPARTMENT OF ECONOMIC SECURITY

Child Protective Services Central Registry, 050C-3

P.O. Box 44240 • Phoenix, AZ 85064-4240

ADOPTIVE FAMILIES CENTRAL REGISTRY RECORDS CLEARANCE

Child Protective Services (CPS) records are confidential and can be released only to those individuals permitted by state (A.R.S. § 8-807) and federal law. This form is to be completed for all household members. The requested information will be used to check the Child Protective Services Central Registry for any history of prior reports. Mail to address above.

ADOPTIVE FATHER’S NAME (Last, First, Middle)

BIRTHDATE

SOC. SEC. NO.

 

 

 

OTHER NAMES USED

 

 

 

 

 

ADOPTIVE FATHER’S ADDRESS (No., Street, City, State, ZIP)

 

 

 

 

 

ADOPTIVE MOTHER’S NAME (Last, First, Middle)

BIRTHDATE

SOC. SEC. NO.

 

 

 

OTHER NAMES USED (Include maiden name and prior married names)

 

 

 

 

 

ADOPTIVE MOTHER’S ADDRESS (No., Street, City, State, ZIP)

 

 

 

 

 

OTHER ADULT HOUSEHOLD MEMBER’S NAME (Last, First, Middle.)

BIRTHDATE

SOC. SEC. NO.

 

 

 

OTHER NAMES USED (Include maiden name and prior married names)

 

 

 

 

OTHER ADULT HOUSEHOLD MEMBER’S ADDITIONAL ADDRESS (No., Street, City, State, ZIP)

 

 

 

 

OTHER ADULT HOUSEHOLD MEMBER’S NAME (Last, First, Middle)

BIRTHDATE

SOC. SEC. NO.

 

 

 

OTHER NAMES USED (Include maiden name and prior married names)

 

 

OTHER ADULT HOUSEHOLD MEMBER’S ADDITIONAL ADDRESS (No., Street, City, State, ZIP)

Children’s Names (Include birth, adopted and any other children living in household)

CHILD’S NAME (Last, First, Middle)

CHILD’S NAME (Last, First, Middle)

CHILD’S NAME (Last, First, Middle)

CHILD’S NAME (Last, First, Middle)

CHILD’S NAME (Last, First, Middle)

BIRTHDATE

BIRTHDATE

BIRTHDATE

BIRTHDATE

BIRTHDATE

I certify that all information provided is true and accurate to the best of my knowledge.

ADOPTING FATHER’S SIGNATURE

 

 

 

DATE

 

 

 

 

 

 

 

 

 

ADOPTING MOTHER’S SIGNATURE

 

 

 

DATE

 

 

 

 

 

 

 

 

 

OTHER ADULT HOUSEHOLD MEMBERS’ SIGNATURE

 

 

 

DATE

 

 

 

 

 

 

 

 

 

NAME OF AGENCY REQUESTING CENTRAL REGISTRY RECORDS CLEARANCE

 

AREA CODE AND PHONE NO.

DATE

 

 

 

 

 

 

 

 

 

CASE MANAGER’S SIGNATURE

 

 

 

DATE

 

 

 

 

 

 

 

 

 

NAME AND ADDRESS OF AGENCY TO RECEIVE INFORMATION FROM

 

TO BE COMPLETED BY CPS PERSONNEL

CENTRAL REGISTRY (THIS BLOCK MUST BE COMPLETED)

 

 

Central Registry information checked

 

 

 

 

 

 

 

 

 

 

 

 

There were no substantiated reports.

 

 

report(s) attached

SIGNATURE OF PERSON CHECKING CENTRAL REGISTRY

DATE

See reverse for Americans with Disabilities Act (ADA) disclosure.

Equal Opportunity Employer/Program ̶ Under Titles VI and VII of the Civil Rights Act of 1964 (Title VI & VII), and the Americans with Disabilities Act of 1990 (ADA), Section 504 of the Rehabilitation Act of 1973, and the Age Discrimination Act of 1975, the Department prohibits discrimination in admissions, programs, services, activities, or employment based on race, color, religion, sex, national origin, age, and disability. The Department must make a reasonable accommodation to allow a person with a disability to take part in a program, service or activity. For example, this means if necessary, the Department must provide sign language interpreters for people who are deaf, a wheelchair accessible location, or enlarged print materials. It also means that the Department will take any other reasonable action that allows you to take part in and understand a program or activity, including making reasonable changes to an activity. If you believe that you will not be able to understand or take part in a program or activity because of your disability, please let us know of your disability needs in advance if at all possible. To request this document in alternative format or for further information about this policy, contact (602) 542-3598; TTY/TTD Services: 7-1-1.

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File Properties

Fact Number Fact Detail
1 The form's official designation is AN-048 (6-06).
2 It is issued by the Arizona Department of Economic Security, specifically by the Child Protective Services Central Registry.
3 The primary purpose is for Adoptive Families Central Registry Records Clearance.
4 Child Protective Services (CPS) records are confidential and governed by state (A.R.S. § 8-807) and federal law.
5 This form is required to be completed by all members of the household.
6 The information collected is used to check the Child Protective Services Central Registry for any history of reports.
7 The form includes sections for adoptive father's, adoptive mother's, other adult household members', and children's names and details.
8 Signing the form certifies that all provided information is true and accurate to the best of the knowledge of the signatory.
9 The form must be mailed to the central registry's address provided at the top of the form.
10 Complies with Equal Opportunity laws and the Americans with Disabilities Act (ADA), offering assistance for those with disabilities.

Instructions on Writing An 048 Arizona

When preparing the AN-048 Arizona form, which is essential for Adoptive Families Central Registry Records Clearance, it's vital to approach the document with attention to detail. This form allows the Arizona Department of Economic Security to review the Child Protective Services (CPS) Central Registry for any prior reports concerning all members of a household. The process requires accurate, comprehensive information to ensure a smooth and efficient handling. Here are the steps to properly fill out the form:

  1. Begin by entering the Adoptive Father’s Name (Last, First, Middle) in the designated space.
  2. Next, provide the Adoptive Father’s Birthdate and Social Security Number (SOC. SEC. NO.).
  3. List all Other Names Used by the Adoptive Father, including maiden names or prior names if applicable.
  4. Fill in the Adoptive Father’s Address (No., Street, City, State, ZIP).
  5. Proceed to enter the Adoptive Mother’s Name (Last, First, Middle).
  6. Provide the Adoptive Mother’s Birthdate and Social Security Number.
  7. Include any Other Names Used by the Adoptive Mother.
  8. Fill out the Adoptive Mother’s Address.
  9. For any Other Adult Household Member’s Name, repeat the steps (Last, First, Middle, including Birthdate, Social Security Number, Other Names Used, and Address).
  10. Under the section for children, list each Child’s Name (Last, First, Middle) living in the household.
  11. Provide each Child’s Birthdate.
  12. Ensure that the Adopting Father and Mother, and Other Adult Household Members sign and date the form where specified.
  13. Complete the section for the Name of Agency Requesting Central Registry Records Clearance, including the Area Code and Phone Number, and have the Case Manager sign and date.
  14. For CPS Personnel only, ensure that the Central Registry section is filled out to indicate if there were no substantiated reports or if there are report(s) attached. The person checking the Central Registry must sign and date this section.

After completing the form with the required information, review it carefully to confirm accuracy. Any discrepancies or errors can lead to delays in the process or inaccurate registry checks. Once verified, mail the form to the Child Protective Services Central Registry at the provided address. By following these instructions carefully, you can ensure that the clearance process proceeds as intended, helping to facilitate a smoother assessment for adoptive families.

Listed Questions and Answers

What is the purpose of the AN-048 Arizona form?

The AN-048 Arizona form is specifically designed for adoptive families undergoing the process of child adoption. Its main purpose is to request a clearance check from the Child Protective Services (CPS) Central Registry. This step is crucial for ensuring that prospective adoptive parents and any other adult living in the household do not have a history of substantiated child abuse or neglect reports.

Who needs to fill out the AN-048 Arizona form?

Every household member aged 18 and over, who resides in a home where an adoption is taking place, must fill out the AN-048 Arizona form. This includes the adoptive father, adoptive mother, and any other adults living at the address. It's important to provide complete information for each person, including all children living in the household, to ensure a thorough background check.

What information is required on the AN-048 form?

To accurately check the CPS Central Registry, the AN-048 form requires detailed information such as the full names (including previous names or maiden names) of the adoptive parents and other adult household members, their social security numbers, birthdates, and addresses. Additionally, you need to list the names and birthdates of all children living in the household. The adoptive parents and other adult members must sign the form, certifying the truthfulness of the information provided.

How is the AN-048 form processed?

Once completed, the form should be mailed to the address provided at the top of the document. A CPS officer will then check the Central Registry for any prior reports related to the individuals mentioned in the form. If there are no substantiated reports, the adoption process can proceed. If there are reports, the specific details will determine the next steps in the adoption eligibility process.

Is there a fee to submit the AN-048 Arizona form?

Typically, there isn't a fee to submit the AN-048 Arizona form for the purpose of adoptive family screening. However, it's always wise to check with the Arizona Department of Economic Security or your adoption agency since policies can change or may vary based on specifics of the adoption process or additional requested services.

What if I need help filling out the form or have questions?

If you encounter difficulties or have questions while filling out the AN-048 form, you should contact the agency that requested the clearance or the Arizona Department of Economic Security directly. They can provide guidance and answer any questions you might have regarding the form or the process it's a part of. Furthermore, accommodations can be made for individuals with disabilities to ensure a smooth and inclusive process for all.

Common mistakes

Filling out the AN-048 Arizona form is an essential step for those going through the adoptive process, ensuring a smooth and lawful transition into becoming a family. However, mistakes can happen. By being aware of common pitfalls, you can avoid unnecessary delays. Here are 10 common mistakes people make when completing this form.

  1. Incorrect Names: Not using the legal names for all members listed, including the adoptive parents, children, and other household members. This includes neglecting to list any other names previously used.
  2. Incomplete Addresses: Failing to provide complete addresses for the adoptive parents and other adult household members, including street number, city, state, and ZIP code.
  3. Forgetting Other Names Used: Omitting maiden names, prior married names, or any other names used in the past by adult household members. This can lead to incomplete background checks.
  4. Social Security Numbers: Inputting incorrect Social Security numbers or leaving this section blank. Accurate Social Security numbers are crucial for accurate record checks.
  5. Children’s Information: Mislisting children’s names, including adopted, biological, and other children living in the household, or providing incorrect birth dates.
  6. Signatures Missing: All adult members must sign the form. Missing signatures lead to the form being considered incomplete.
  7. Agency Information: Not correctly filling in the name and address of the agency requesting the clearance, which can cause delays in processing.
  8. Date Errors: Forgetting to date signatures, which is essential for record purposes and tracking the timeline of the application process.
  9. Unverified Information: Certifying that the provided information is accurate without thoroughly checking can lead to discrepancies and possible legal issues.
  10. Failing to Request Document in Alternative Format: For individuals with disabilities, not requesting the document in an accessible format can make completing it accurately more challenging.

Adoptive families play a pivotal role in providing a nurturing environment for children. Taking the time to meticulously complete the AN-048 form is the first step in ensuring a seamless integration for every member involved. Avoiding these frequent mistakes not only facilitates a smoother process but also exemplifies the commitment to welcoming a new family member with open arms and due diligence.

Documents used along the form

When handling matters related to child protective services or undergoing processes such as adoption in Arizona, the AN-048 form is an essential document. However, it's seldom the only document needed. Various other forms and documents often accompany the AN-048 form to ensure a comprehensive and compliant application process. Let’s take a look at some of these documents and briefly describe their purpose.

  • Application for Adoption: This is a formal request to adopt a child, providing detailed information about the prospective adoptive parents and their household.
  • Home Study Report: A document prepared by a licensed agency detailing the living environment, family background, and readiness of the adoptive family for adoption, based on interviews and home visits.
  • Medical History Reports: Health records of the adoptive applicants and all household members, helping assess the home’s suitability for child placement.
  • Background Check Consent Forms: These authorize the state to conduct criminal and background checks on all adult members of the household, ensuring the child's safety.
  • Financial Information Form: A document that outlines the financial status of the adoptive family, including income, expenses, assets, and liabilities, to evaluate the family’s financial ability to support an adopted child.
  • References Form: Forms used to collect references from non-family members, providing insight into the character and suitability of the prospective adoptive parents from a third-party perspective.
  • Post-Placement Reports: These reports are compiled after a child has been placed with the adoptive family, assessing the adjustment of the child and the family to the adoption.
  • Finalization Papers: The legal documents submitted to a court to request the finalization of an adoption, officially making the child a legal member of the adoptive family.

Each of these documents plays a vital role in the adoption process or in ensuring the safety and well-being of a child in foster care. By using them in conjunction with the AN-048 form, families, social workers, and legal professionals can work together more efficiently to support the best interests of children in Arizona. Remember, it's always helpful to work closely with a professional to ensure that all paperwork is properly completed and filed, streamlining the process for all involved.

Similar forms

The Form I-800A, Application for Determination of Suitability to Adopt a Child from a Convention Country, is fundamentally similar to the An 048 Arizona form in its requirement for extensive background checks. Like the An 048 form, the I-800A is a critical initial step in the adoption process, requiring prospective parents to provide detailed personal information, including past addresses and family composition. Both documents are designed to ensure the safety and welfare of children by scrutinizing the backgrounds of potential adoptive families. However, while the An 048 form focuses specifically on the Child Protective Services Central Registry in Arizona, the I-800A has a broader scope, involving federal and international considerations for intercountry adoption.

The Foster Care Licensing application, another pivotal document in child welfare, shares objectives with the An 048 Arizona form. It mandates thorough checks of household members to protect the interests and safety of foster children. Both forms collect detailed personal information about the household members and require their consent to conduct background checks. The key similarity lies in their function to screen individuals for any history of abuse or neglect that would disqualify them from providing a safe home environment, although the foster care application encompasses broader licensing requirements beyond child protective services checks.

The Criminal History Record Check (CHRC) forms used by many organizations, including schools and childcare facilities, mirror the An 048 form in their aim to safeguard children's well-being. These forms necessitate the submission of personal information to scrutinate one’s criminal background, akin to the An 048’s objective with the Child Protective Services Central Registry. Although the CHRC forms are more generalized in scope, targeting any criminal activities, both forms serve a protective role, ensuring individuals with potentially harmful backgrounds are identified before engaging with vulnerable populations.

The Adoption Tax Credit form (IRS Form 8839) shares a contextual similarity with the An 048 Arizona form since it is part of the adoption process. While the Adoption Tax Credit form is used for claiming adoption-related expenses on federal taxes, and not for background checks, it connects with the AN-048 form by facilitating a crucial step in the adoption journey of a family. Both are instrumental in adopting processes, with one ensuring the financial aspects and the other focusing on the safety and eligibility checks.

The Child Abuse Registry Check consent forms, utilized in various states, are closely related to the An 048 Arizona form in their purpose and application. They authorize the review of an individual’s records within the state’s child abuse registry to identify any instances of substantiated abuse or neglect. This parallels the An 048 form’s role in accessing the Child Protective Services Central Registry for similar reasons. While each state’s registry has its own parameters and scope, the fundamental aim of protecting children from potential harm unites these documents, highlighting their vital roles in child safety protocols.

Dos and Don'ts

When completing the AN-048 Arizona Department of Economic Security Child Protective Services Central Registry Records Clearance form, accuracy, and diligence are vital. This form plays a crucial role in ensuring the safety and welfare of all household members in adoptive situations. To guide you through the completion process, here is a list of do's and don'ts:

  • Do ensure that every piece of information you provide is true and accurate. The integrity of the details you furnish can significantly affect the outcome of your application.
  • Do include all previously used names for each individual. This includes maiden names, prior married names, or any other aliases to ensure a comprehensive background check.
  • Do verify the Social Security numbers (SSNs) and birth dates provided for all individuals, including adult household members and children. Incorrect information can delay the process.
  • Do list every child living in the household, not just those being adopted, to fulfill the comprehensive checks as required by the form's instructions.
  • Do provide a current address for every household member, and ensure it matches the official records. Discrepancies in addresses could complicate the clearance process.
  • Don't leave any section incomplete. If a section does not apply, indicate this by writing "N/A" (for "Not Applicable") instead of leaving it blank.
  • Don't sign the form until all the information is verified and complete. Your signature certifies that you believe the information is true and accurate to the best of your knowledge.
  • Don't hesitate to contact the agency for clarification if there are any parts of the form or processes you do not understand fully. Clear and transparent communication can prevent mistakes.
  • Don't forget to check and comply with both state (A.R.S. § 8-807) and federal laws regarding the confidentiality and disclosure of the information provided on this form. Understanding these laws can help you fill out the form more accurately.

Filling out the AN-048 form is a responsibility that should be approached with care and attention to detail. Ensuring the accuracy and completeness of every entry not only facilitates a smoother process but also supports the overarching goal of safeguarding the welfare of children in adoptive family arrangements. Always remember, reaching out to professionals for guidance is a sensible step if you encounter any difficulties or uncertainties along the way.

Misconceptions

There are several misconceptions about the AN-048 Arizona form used by the Arizona Department of Economic Security for Child Protective Services Central Registry checks, especially in the context of adoptive families. Let's clarify these misconceptions.

  • It's only for adoptive parents: While the form is primarily used by adoptive families, it must be completed for all household members, not just the parents. This includes any other adults living in the household.
  • Confidentiality is not a priority: Contrary to what some might think, the information collected on this form is highly confidential and can only be released to those individuals permitted by state and federal law.
  • Social Security numbers are optional: The form requires Social Security numbers for all parties involved. This isn't optional but a mandatory field to accurately conduct the background checks.
  • Signing the form isn't important: Every adult household member mentioned on the form must sign it, verifying that the information provided is true and accurate. This is crucial for the process.
  • The form doesn't need to be comprehensive: Inaccurate or incomplete forms can lead to delays or negative outcomes. It's essential that all fields are filled out correctly and completely.
  • Personal addresses are irrelevant: The form asks for both the adoptive parents' and any other adult household members' addresses for a reason. It's not just a formality; it's a necessary part of the clearance check.
  • Information on children is for demographic purposes only: The children's names and birth dates are required to check the household's background comprehensively, not just for demographic statistics.
  • Agencies requesting the clearance are not important: The name and contact details of the agency requesting the clearance are crucial for proper communication and record-handling.
  • ADA compliance is unrelated: The form includes an ADA disclosure, emphasizing the Department's commitment to accommodating all individuals, a critical aspect for inclusivity.

Understanding these misconceptions can help ensure that the submission process for the AN-048 Arizona form is done correctly and efficiently, benefiting all parties involved in the adoptive process.

Key takeaways

Filling out and using the AN-048 Arizona form, which is crucial for adoptive families seeking clearance from the Child Protective Services (CPS) Central Registry, comes with significant responsibilities and considerations. Here are seven key takeaways to help navigate this process:

  • Confidentiality is paramount: The form is subject to state (A.R.S. § 8-807) and federal laws that protect the confidentiality of CPS records. Only individuals authorized by these laws may access these records.
  • Comprehensive information is required: This form mandates detailed personal information for all household members, including full names, birthdates, social security numbers, and any other names used, such as maiden names or prior married names.
  • Accuracy matters: It’s critical to ensure that all information provided on the form is true and accurate to the best of one's knowledge. This is not only a matter of legal integrity but also crucial for the accuracy of the CPS Central Registry check.
  • Signature requirement: The form requires signatures from the adopting father, adopting mother, and any other adult household members. These signatures serve as a certification of the accuracy and truthfulness of the information provided.
  • Agency information: The form must include the name and contact details of the agency requesting the Central Registry records clearance, underscoring the importance of coordination between adoptive families and the responsible agencies.
  • Central Registry check: A designated section for CPS personnel indicates whether there were any substantiated reports or not, which is crucial for the approval process in adoption cases.
  • ADA Considerations: The form also outlines accommodations under the Americans with Disabilities Act (ADA), ensuring that all individuals, regardless of disability, have equal access and opportunity to participate in the process.

Understanding these key aspects can significantly ease the process for adoptive families and help ensure a smooth and compliant journey through the necessary legal procedures surrounding adoption.

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