APPENDIX 11.
AR ADC 016.15.4 App. 11Arkansas Administrative CodeEffective: January 1, 2020
Effective: January 1, 2020
Ark. Admin. Code 016.15.4 App. 11
APPENDIX 11.
Arkansas Department of Human Services
Division of Children and Family Services
True But Exempted Child Maltreatment Investigative Determination Notice to Alleged Juvenile Offender 14-17 Years of Age
To: ____________________________________________________________
Address: ____________________________________________________________
____________________________________________________________
From: ____________________________________________________________
____________________________________________________________
____________________________________________________________
Phone: ____________________________________________________________
County of Referral: ____________________ Primary Assigned County: _________________________
Date: ______________________________ CHRIS Referral # ______________________________
Certified Mail # ____________________
Re: Name of Alleged Offender: _______________________________________________________
Name of Alleged Victim(s): ____________________________________________________________
The Division of Children and Family Services (DCFS) or Arkansas State Police's Crimes Against Children Division (CACD) received an allegation of suspected child maltreatment involving the above named people. The incident was reported on (date) __________.
The type of maltreatment was ____________________________________________________________.
Pursuant to Arkansas Code Ann. § 12-18-703, this is your notice that based on the preponderance of the evidence, the investigative agency determined the allegation to be:
True but exempted, and your name will not be placed in the Child Maltreatment Central Registry because the report was true for neglect as defined at A.C.A. § 12-18-103(14)(B) (i.e., investigation documented the presence of an illegal substance in either the bodily fluids or bodily substances in either the mother or the child at the time of birth, also known as Garrett's Law). True but exempted, and your name will not be placed in the Child Maltreatment Central Registry because you were practicing your religious beliefs as permitted by the law. True but exempted, and your name will not be placed in the Child Maltreatment Central Registry because a determination was made that you do not pose a risk of maltreatment to vulnerable populations.Juveniles, fourteen (14) to seventeen (17) years old at the time of the act or omission that resulted in the true finding will automatically have an administrative hearing. The juvenile offender or the parent can decline the automatic administrative hearing by submitting a signed request to: Office of Appeals & Hearing, SLOT N401, P.O. Box 1437, Little Rock, AR 72203. Administrative hearings are conducted telephonically, unless the offender, his parent, guardian, or attorney asks that the hearing be held in person. The request for an in-person hearing must be made within thirty (30) days of this notice and mailed to the Office of Appeals & Hearing (see address listed above).
If you want to obtain a copy of the investigative report, send a $10.00 check or money order along with a written, notarized request to the Arkansas Department of Human Services, Division of Children & Family Services, Central Registry Unit, P.O. Box 1437, SLOT S566, Little Rock, AR 72203. The request must contain your name, address and the names of the child(ren) involved.
You have the right to an attorney. If you cannot afford one you should contact Legal Services.
Pursuant to Arkansas Code Ann. § 12-18-1007, the Division of Children and Family Services may offer you and your family supportive services for which you qualify, should you desire them. Supportive services can provide things like counseling, parenting classes, and other assistance or services. Each case is different and the services available to you may vary.If you would like to receive supportive services or would like more information on the services available to you and your family, please contact your local county office, listed above.
Pursuant to Arkansas Code Ann. § 12-18-1010, the Division of Children and Family Services may open a protective services case for your family. The Division shall provide services to your family in an effort to prevent additional maltreatment to your child or the removal of your child from your home.________________________________________
DCFS INVESTIGATOR PRINTED NAME
________________________________________
MAILED BY
Arkansas Department of Human Services
Division of Children and Family Services
Child Maltreatment True But Exempted Investigative Determination Notice to
Legal Parents Legal Guardiansof the Alleged Juvenile Offender (14 through 17 Years of Age)
To: ____________________________________________________________
Address: ____________________________________________________________
____________________________________________________________
From: ____________________________________________________________
____________________________________________________________
Title: ____________________________________________________________
Phone: ____________________________________________________________
County of Referral: ____________________ Primary Assigned County: ____________________
Date: ________________________________________ CHRIS Referral # ____________________
Re: Name of Alleged Offender: _______________________________________________________
Name of Alleged Victim: ____________________________________________________________
The Division of Children and Family Services or Arkansas State Police's Crimes Against Children Division received an allegation of suspected child maltreatment involving the above named person. The incident was reported on (date) ____________________.
Pursuant to Arkansas Code Ann. § 12-18-704 this is your notice that based on the preponderance of the evidence, the investigative agency determined the allegation to be:
True but exempted, and the offender's name will not be placed in the Child Maltreatment Central Registry because the report was true for neglect as defined at Arkansas Code Ann. § 12-18-103(14)(B) (i.e., investigation documented the presence of an illegal substance in either the bodily fluids or bodily substances in either the mother or the child at the time of birth, also known as Garrett's Law). True but exempted, and the offender's name will not be placed in the Child Maltreatment Central Registry because you were practicing your religious beliefs as permitted by the law. True but exempted, and the offender's name will not be placed in the Child Maltreatment Central Registry because a determination was made that the offender does not pose a risk of maltreatment to vulnerable populations.The type of maltreatment was ________________________________________.
Juveniles, fourteen (14) to seventeen (17) years old at the time of the act or omission that resulted in the true finding will automatically have an administrative hearing. The juvenile offender or the parent can decline the automatic administrative hearing by submitting a, signed request to: Office of Appeals & Hearing, SLOT N401, P.O. Box 1437, Little Rock, AR 72203. Administrative hearings are conducted telephonically, unless the offender, his parent, guardian, or attorney asks that the hearing be held in person. The request for an in-person hearing must be made within thirty (30) days of this notice and mailed to the Office of Appeals & Hearing (see address listed above).
To obtain a copy of the investigative report, send a $10.00 check or money order along with a written, notarized request to the Division of Children & Family Services, Central Registry Unit, P.O. Box 1437, SLOT S566, Little Rock, AR 72203. The request must contain your name, address and the names of the child(ren) involved.
You have the right to an attorney. If you cannot afford one, you should contact Legal Services.
Pursuant to Arkansas Code Ann. § 12-18-1007, the Division of Children and Family Services may offer your family supportive services for which you qualify, should you desire them. Supportive services can provide things like tutoring, counseling, parenting classes, and other assistance or services. Each case is different and the services available to you may vary.If you would like to receive supportive services, or would like more information on the services available to you and your family, please contact your local county office, listed above.
Pursuant to Arkansas Code Ann. § 12-18-1010, the Division of Children and Family Services may open a protective services case for your family. The Division shall provide services to your family in an effort to prevent additional maltreatment to your child or the removal of your child from your home.________________________________________
DCFS INSVESTIGATOR PRINTED NAME
________________________________________
MAILED BY
Arkansas Department of Human Services
Division of Children and Family Services
True But Exempted Child Maltreatment Investigative Determination Notice to Offender
To: ____________________________________________________________
Address: ____________________________________________________________
____________________________________________________________
From: ____________________________________________________________
____________________________________________________________
____________________________________________________________
Phone: ____________________________________________________________
County of Referral: ____________________ Primary Assigned County: _________________________
Date: ______________________________ CHRIS Referral # ___________________________________
Certified Mail # ______________________________
Re: Name of Alleged Offender: _______________________________________________________
Name of Alleged Victim(s): ____________________________________________________________
The Division of Children and Family Services (DCFS) or Arkansas State Police's Crimes Against Children Division (CACD) received an allegation of suspected child maltreatment involving the above named people. The incident was reported on (date) ____________________.
The type of maltreatment was ____________________________________________________________.
Pursuant to Arkansas Code Ann. § 12-18-703, this is your notice that based on the preponderance of the evidence, the investigative agency determined the allegation to be:
True but exempted, and your name will not be placed in the Child Maltreatment Central Registry because the report was true for neglect as defined at A.C.A. § 12-18-103(14)(B) (i.e., investigation documented the presence of an illegal substance in either the bodily fluids or bodily substances in either the mother or the child at the time of birth, also known as Garrett's Law). True but exempted, and your name will not be placed in the Child Maltreatment Central Registry because you were practicing your religious beliefs as permitted by the law. True but exempted, and your name will not be placed in the Child Maltreatment Central Registry because a determination was made that you do not pose a risk of maltreatment to vulnerable populations.If you disagree with the investigative determination, you may request an administrative hearing within 30 days of receipt of this notice. To request an administrative hearing, you must mail a copy of this form along with your request to the: Office of Appeals & Hearing, SLOT N401, P.O. Box 1437, Little Rock, AR 72203. Administrative hearings are conducted telephonically, unless you ask that the hearing be held in person. The request for an in-person hearing must be noted on your request for an administrative hearing. You have the right to an attorney; if you cannot afford one you should contact Legal Services.
If you want to obtain a copy of the investigative report, send a $10.00 check or money order along with a written, notarized request to the Arkansas Department of Human Services, Division of Children & Family Services, Central Registry Unit, P.O. Box 1437, SLOT S566, Little Rock, AR 72203. The request must contain your name, address and the names of the child(ren) involved.
__________________________________________________
DCFS INVESTIGATOR PRINTED NAME
__________________________________________________
MAILED BY
Arkansas Department of Human Services
Division of Children and Family Services
REQUEST FOR CHILD MALTREATMENT CENTRAL REGISTRY CHECK
THIS FORM WILL NOT BE PROCESSED UNTIL ALL INFORMATION IS COMPLETED.
TYPE OF APPLICANT:
DHS Employee/Applicant [Division: ____________________ Foster Parent Legal Custodian Adoptive Parent Provisional Foster Parent Foster Family Support System (FFSS) for: Name of Foster Family whom FFSS will support ______________________________ Other (This request will be processed for a fee of $10 made payable by check or money order to DHS. We do not accept cash. This fee may be waived for non-profits who provide proof of 501(c)(3) status and for a person who is indigent. Allow 7-10 business days for processing.)This information should be addressed to:
______________________________ | ______________________________ |
Name/Title (print) | Organization Requesting the Report |
______________________________
______________________________ | __________ | ____________________ |
Address (physical) | Telephone # | Fax # |
______________________________
______________________________
Address (provide mailing, if different than physical)
Name of Applicant: ____________________________________________________________
Maiden Name/Other Names Used: _______________________________________________________
Race: __________ Sex: _____ Age/DOB: __________ / __________ SSN: _________________________
Present Address: (since __________, _____) __________________________________________________
Previous Addresses (from the last six years): _____________________________________________
1) ______________________________ | 2) ______________________________ |
______________________________ | ______________________________ |
From __________ to __________ | From __________ to __________ |
3) ______________________________ | 4) ______________________________ |
______________________________ | ______________________________ |
From __________ to __________ | From __________ to __________ |
Cities and States of Employment (outside of Arkansas) for last six years:
1) ______________________________ | 2) ______________________________ |
______________________________ | ______________________________ |
From __________ to __________ | From __________ to __________ |
3) ______________________________ | 4) ______________________________ |
______________________________ | ______________________________ |
From __________ to __________ | From __________ to __________ |
Children (related or non-related) now residing or who have resided in the home at any time and all biological children, even if they have not resided in the home:
Full Name: ____________________ | Full Name: ____________________ |
DOB/Age: __________ / _______________ | DOB/Age: __________ / _______________ |
Relationship: ____________________ | Relationship: ____________________ |
SS#: ______________________________ | SS#: ______________________________ |
Full Name: ____________________ | Full Name: ____________________ |
DOB/Age: __________ / ____________________ | DOB/Age: __________ / ____________________ |
Relationship: ____________________ | Relationship: ____________________ |
SS#: ____________________ | SS#: ____________________ |
THE FOLLOWING IS TO BE COMPLETED ONLY WITH A NOTARY
I, ______________________________ verify that the information above is true and complete. I authorize the Arkansas Child Maltreatment Central Registry to release any information their files may contain concerning me as an offender of a true report of child maltreatment.
______________________________ | ______________________________ |
Signature of Applicant | Date |
County of ______________________________ State of Arkansas
Acknowledged before me, this __________ day of ______________________________, __________
________________________________________
Notary Public
My commission expires: ____________________
THE FOLLOWING IS TO BE COMPLETED BY CENTRAL REGISTRY
The Arkansas Child Maltreatment Central Registry contains no record under the referenced name in a true report of child maltreatment.Examiner's Initials and Date ________________________________________
Please note that whenever there is a determination of child maltreatment, the person identified as the offender has the right to a hearing to contest that determination. The person's name may not be placed in the Central Registry until after the hearing decision. Therefore, the absence of a true report in the Child Maltreatment Central Registry does not imply that the person is or is not the subject of a completed child maltreatment investigation. Please check the Central Registry periodically as names can be added to the Central Registry based on new maltreatment reports and upon final administrative determination.
Information FoundExaminer's Signature and Date | ______________________________ | __________ |
Child Maltreatment Central Registry | ||
Slot S 566 | ||
P O Box 1437 | ||
Little Rock AR 72203 |
ARKANSAS DEPARTMENT OF HUMAN SERVICES
Division of Children and Family Services
Central Registry Unit Slot S 566
P.O. Box 1437, • Little Rock, AR 72203-1437
501-682-0405 • Fax: 501-682-0407 • TDD: 501-682-1442
To:
From: Child Maltreatment Central Registry Review Team
In the matter of referral # __________, the Arkansas Department of Human Services (DHS) Child Maltreatment Central Registry Review Team has reviewed your request to be removed from the Arkansas Child Maltreatment Central Registry. Please note that the Child Maltreatment Central Registry Review Team only considers whether a name may be removed from the Arkansas Child Maltreatment Central Registry. It does not determine whether the initial investigation finding of true was the appropriate finding.
After consideration of the evidence provided, the Team has determined in its __________ 20 __________, meeting that this request for removal is:
Granted Denied Placed on HoldThe reason(s) for this decision is/are as follow:
Please note that if the request has been denied, the offender must wait one year from the date of this removal request before filing a new petition with the Division requesting the offender's name be removed from the Arkansas Child Maltreatment Central Registry.
You may request an administrative hearing to appeal this decision. If you choose to request an administrative hearing, you must make the request in writing within thirty (30) days of receipt of this letter.
Mail your request for an administrative hearing with a copy of this letter to:
Office of Appeals & Hearings
Slot N 401
P O Box 1437
Little Rock, AR 72206
(501) 682-8622
Notice: This notification letter has been processed on behalf of the Arkansas DHS Child Maltreatment Central Registry Review Team by designated personnel who are not part of, and are unable to answer questions pertaining to the DHS Child Maltreatment Central Registry Review Team's decision processes.
Credits
Adopted Jan. 1, 2020.
Current with amendments received through February 15, 2024. Some sections may be more current, see credit for details.
Ark. Admin. Code 016.15.4 App. 11, AR ADC 016.15.4 App. 11
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