RCPA - Rehabilitation and Community Providers Association


New Child Abuse History Clearance Form and Web Site
March 29, 2012

The Department of Public Welfare (DPW) has revised the Pennsylvania Child Abuse History Clearance form (CY113). It is available at  http://www.dpw.state.pa.us/findaform/childabusehistoryclearanceforms/index.htm.

The revised form has a new number, CY113 (UF) 6/11, located in the bottom right hand corner of the form.  The revised form is now “data enterable” and information can be typed directly into the form.  Users must have a licensed version of Adobe Acrobat Reader to enter data, but will not be able to save the form with information entered.  Instead, the person completing the form must print the form immediately after entering in order to maintain and submit the information.  A blank copy of the form can be saved on a user’s computer for future use.  Additionally:

  • The form is now available in English and Spanish, and
  • The clearance section includes more refined options from which to choose such as
    • Child care services employee,
    • Foster care,
    • Adoption,
    • School Employee,
    • Employment with a significant likelihood of regular contact with children,
    • Volunteers, and
    • DPW Employment & Training Program participants,

Instructions for completing the form are attached to the form; instructions will print with the completed document. DPW will continue to accept the old form until April 1, 2013. 

Child abuse clearances must continue to be mailed via the US Postal service. DPW is encouraging agencies, businesses, and organizations to use the electronic form to produce their own copies.  The ChildLine Verification Unit will accept copies of the form as long as the applicant’s signature appears. Questions may be directed to Terry Clark (teclark@pa.gov or 717-214-9545).

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