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Fill in Your Ldss 3370 Template

The LDSS-3370 form is a crucial document used for conducting a Statewide Central Register Database Check in New York. This form collects essential information about applicants and their household members to ensure safety in child care settings. Completing it accurately is vital, as any errors can lead to delays or complications in the screening process.

Table of Contents

The LDSS-3370 form is a crucial document used in the process of conducting background checks through the Statewide Central Register (SCR) for various purposes, including adoption, foster care, and childcare services. Accurate completion of this form is essential to ensure that the data entry and resulting checks are reliable. The form requires detailed agency information, including the agency code and contact details, as well as comprehensive applicant information. Every household member, regardless of their relationship to the applicant, must be listed. This includes adults and children, ensuring that all names are recorded clearly, with proper identification of relationships and relevant personal details such as dates of birth. The form also mandates a thorough address history for the last 28 years, particularly for certain categories like adoption and foster care. Signatures from the applicant and any adult household members are necessary, affirming the accuracy of the information provided. Incomplete or illegible forms will be returned for correction, underscoring the importance of clarity and precision. Understanding the requirements and correctly filling out the LDSS-3370 can significantly impact the outcome of the background check process.

Sample - Ldss 3370 Form

LDSS-3370 (Rev. 12/2019) DCCS version

Instructions for Completing the Statewide Central Register

Database Check Form LDSS-3370, DCCS version

ALL information on the LDSS-3370, DCCS version must be easily read so that data entry and results are accurate. Each Statewide Central Register Database Check form LDSS-3370, DCCS version submitted should be reviewed for completeness and legibility by the program/agency liaison. If the form is incomplete or illegible, it will be returned to the agency for corrections.

HOW TO COMPLETE THE FORM:

AGENCY INFORMATION

TOP LINE OF FORM

•The three-digit agency code must be placed in the top left-hand box, followed by the Resource I.D. (RID) in the next box to the right. (Contact the licensing agency if there are any questions about these.)

•Day Care providers must place their Child Care Facility System (CCFS) Number in the box next to Resource ID (RID), in lieu of RID number. (Contact your licensing agency/regional office if you have any questions).

•Clearance Category letter code (see the back of form LDSS-3370, DCCS version) must be placed in the middle box.

•Phone number (with area code) enables the SCR to contact the agency liaison if this becomes necessary.

•The Request ID Box is for SCR use only.

AGENCY ADDRESS AREA

•Agency Name: Please use full name, no abbreviations

•Agency Liaison is the contact person at the inquiring agency. (The SCR response will be addressed to the liaison.) The liaison cannot be the applicant or a relative of the applicant.

•Agency Address: Must include street and city

APPLICANT INFORMATION

APPLICANT/HOUSEHOLD MEMBER AREA

ALL HOUSEHOLD MEMBERS, ADULTS AND CHILDREN, WHETHER RELATED TO THE APPLICANT OR NOT, ARE TO BE LISTED IN THIS AREA OF THE FORM.

Remember to write clearly or type all information to assist in obtaining an accurate response. Record all names with the last name first, then the first name, and middle name.

•First line: Applicant’s name. If there is more than one applicant place the additional name(s) on the lines below the maiden name line.

•Second line: Any maiden names, previous married names, or aliases by which the applicant is or has been known. Use additional lines if there is more than one maiden/married/alias name to be listed.

•Remaining lines: Names of all other household members. (Attach an additional page if needed.)

IF THERE ARE NO OTHER HOUSEHOLD MEMBERS, PLEASE CHECK BOX FOR NO OTHER HOUSEHOLD MEMBERS.

•First column: indicate the relationship to the applicant of each person listed. (Spouse, son, daughter, mother, father, friend, etc.)

•Sex M/F column: check either M (Male) or F (Female) for every person listed.

•Date of Birth column: fill in complete date of birth (mm/dd/yyyy) for everyone listed on the form.

ADDRESS AREA

The information required varies depending on the category (see the back of the form for categories).

•For Adoption, Foster Care and Family and Group Family Day Care, provide addresses for the applicant and any household member who is 18 years of age or older. For legally-exempt Family Child Care provide addresses for the applicant and any household member who is 18 years of age or older, unless the household member is related in any way to all children in care. This information must date back to the last 28-years. Attach supplemental pages if necessary, but do not use another LDSS-3370, DCCS version form to list this additional information. Be sure to associate address histories with individuals (i.e., indicate which addresses are for which household member).

•For all other categories, only the applicant’s address history is required – for the last 28-years.

•Complete addresses are required. Include street name, street number, apartment number and city/town/village. Post Office Box numbers are not acceptable. If the applicant has lived abroad, indicate country and dates (months/years) of residence. If the applicant has spent time in the military, list base names and locations along with dates (months/years).

•Be sure that there are no periods of time unaccounted for.

•The top line is for the current address. The previous address should be listed on the second line downward, and so on, to the back of the form for the last 28-years. Staple the attached supplemental page to the form if more space is needed, but do not use another copy of the LDSS-3370, DCCS version for this additional information.

SIGNATURE AREA

•Signatures required depend upon the category (see the back of the form for categories).

•For Adoption, Foster Care and Family and Group Family Day Care, signatures are needed from the applicant and any household member who is 18 years of age or older. For legally-exempt Family Child Care, signatures are needed from the applicant and any household member who is 18 years of age or older unless the household member is related in any way to all children in care.

•For all other categories, only the applicant’s signature is required.

•All signatures must correspond to the names recorded in the Applicant/Household Member Area. For example: Mary Smith should not sign Mary Ann Smith. Victoria Smith should not sign Vicki.

•Applicants must sign in the boxes marked Applicant’s Signature; household members over 18 years of age who are not applicants must sign in the boxes at the extreme bottom of the page marked Signature.

•All signatures must be dated (mm/dd/yyyy). The SCR will not accept a form with a signature date more than six-months old.

If you have questions regarding completion of this form, please call the SCR at 518-474-5297.

SUBMIT YOUR COMPLETED LDSS-3370, DCCS VERSION TO THE PERSON REFERENCED IN OCFS-6000

INCLUDE THE REQUIRED FEE FOR EACH APPLICANT FOR EMPLOYMENT/TO BE A CHILD CARE PROVIDER

TO ORDER A SUPPLY OF FORM, LDSS-3370, DCCS version:

Please access the OCFS-4627, Request for Forms and Publications, from the Intranet: http://ocfs.state.nyenet/admin/forms/Management_Services/

Internet http://ocfs.ny.gov/main/documents/forms_keyword.asp and mail the completed OCFS-4627, Request for Forms and Publications to: THE NEW YORK STATE

OFFICE OF CHILDREN AND FAMILY SERVICES, FORMS AND PUBLICATIONS UNIT, 52 WASHINGTON ST. ROOM 116 SOUTH BLDG., RENSSELAER, NY 12144.

LDSS-3370 (Rev. 12/2019) DCCS version FRONT

NEW YORK STATE

OFFICE OF CHILDREN AND FAMILY SERVICES

STATEWIDE CENTRAL REGISTER DATABASE CHECK

Agency Use Only

SCR USE ONLY

REQUEST I.D.:

ALL INFORMATION MUST BE COMPLETE. PLEASE PRINT OR TYPE

AGENCY CODE:	RESOURCE I.D. (RID)		CHILD CARE FACILITY SYSTEM (CCFS) NUMBER:		CATEGORY (Use alpha codes on reverse):	PHONE NUMBER (Area Code):
						( )	-

PRINT BELOW THE ADDRESS ASSOCIATED WITH YOUR RID/CCFS NUMBER:					The particular classifications of persons who must or may be screened
AGENCY					are set forth on the reverse side of this document. The alpha codes to
AGENCY					complete the “Category” box above, are also on the reverse side of this
NAME:
NAME:					form.

AGENCY
AGENCY					FOR ALL CATEGORIES: Complete the following for yourself, your
LIAISON:
LIAISON:					spouse, your children and any other person(s) in your home at the

STREET					present time. MAKE SURE YOU COMPLETE ALL MAIDEN
ADDRESS:					NAME/ALIAS/MARRIAGE SECTIONS THAT APPLY. IF NONE,
					STATE “NONE” List RELATIONSHIP in the fields below.
CITY:		STATE:		ZIP CODE:	STATE “NONE” List RELATIONSHIP in the fields below.
CITY:		STATE:		ZIP CODE:	(see reverse side for instructions) Attach additional page if necessary.

The purpose of collecting the demographic data on other persons in your household who are not screened pursuant to Section 424-a of the Social Services Law is to enable the NYS Office of Children and Family Services to identify with the greatest degree of certainty whether the person(s) being screened is the subject of an indicated child abuse or maltreatment report. The utilization of this information in a discriminatory manner is contrary to the Human Rights Law.

APPLICANT/HOUSEHOLD MEMBER AREA		PLEASE TYPE OR PRINT CLEARLY
IF THERE ARE NO OTHER HOUSEHOLD MEMBERS, PLEASE CHECK THIS BOX.

RELATIONSHIP TO	LAST NAME	FIRST NAME	SEX	DATE OF BIRTH
APPLICANT	LAST NAME	FIRST NAME	M/F	mm	dd	yyyy
APPLICANT			M/F	mm	dd	yyyy
APPLICANT			M
APPLICANT			F
APPLICANT MAIDEN/ALIAS/			M
MARRIED NAME			F
			M
			F
			M
			F
			M
			F
			M
			F
			M
			F
			M
			F
			M
			F

Please provide your current address and any other addresses at which you have resided for the last 28-years, including street, street number, city and state. For Adoption, Foster Care, Family and Group Family Day Care and legally-exempt Family Child Care, also include the same address history for household members 18 years of age or older.

CURRENT STREET ADDRESS	APT #	CITY	STATE	ZIP	FROM (Mo/Yr)	TO (Mo/Yr)
					/	/

PREVIOUS STREET ADDRESS	APT #	CITY	STATE	ZIP	FROM (Mo/Yr)	TO (Mo/Yr)
					/	/

PREVIOUS STREET ADDRESS	APT #	CITY	STATE	ZIP	FROM (Mo/Yr)	TO (Mo/Yr)
					/	/

PREVIOUS STREET ADDRESS	APT #	CITY	STATE	ZIP	FROM (Mo/Yr)	TO (Mo/Yr)
					/	/

PREVIOUS STREET ADDRESS	APT #	CITY	STATE	ZIP	FROM (Mo/Yr)	TO (Mo/Yr)
					/	/

I affirm that all the information provided on this form is true to the best of my knowledge. I understand that if I knowingly give false statements, such action could be grounds for denial or dismissal from employment or denial or revocation of a license, certificate, permit, registration or approval.

APPLICANT’S SIGNATURE	DATE (mm/dd/yyyy)
	/	/

EIGHTEEN-YEARS OF AGE OR OLDER:

APPLICANT’S SIGNATURE

DATE (mm/dd/yyyy)

/ /

I understand that as a person 18 years of age or older in a home of an applicant to become an Adoptive or a Foster Parent or a Family or Group Family Day Care provider or a legally-exempt family child care provider, the information I have provided will be used to inquire of the Statewide Central Register to determine if I am the subject of an indicated report of child abuse or maltreatment.

SIGNATURE

DATE (mm/dd/yyyy)

/ /

SIGNATURE

DATE (mm/dd/yyyy)

/ /

LDSS-3370 (Rev. 12/2019) DCCS version REVERSE

AGENCY LIAISON INSTRUCTIONS

Please verify that each form is completed. Incomplete forms will be returned to the sender. For ADOPTION, FOSTER CARE, and FAMILY and GROUP FAMILY DAY CARE, if both spouses are applicants, both are to sign. Persons 18 years of age or older residing in the home of applicants for ADOPTION, FOSTER CARE and FAMILY AND GROUP FAMILY DAY CARE also must sign the form.

AGENCY CODE: Record your three-digit agency code. NOTE: Day Care, Family and Group Family Day Care and Camps must provide the agency code of the agency or office which issues your license or certificate. Verify your Alpha or Alpha/Numeric three-digit code with your licensing agency.

DAYCARE PROVIDERS: Must place their Child Care Facility System (CCFS) Number in the box next to Resource ID (RID), in lieu of RID number. (Contact your licensing agency/regional office if you have any questions).

RESOURCE I.D. (RID): Record your RID in this field. OCFS, OMH, OMRDD, DOH, OASAS and SED licensed agencies and programs and local departments of social services, have RIDs as of 9/2001. Verify your RID with your licensing agency. If you need assistance, email: [email protected]

CLEARANCE CATEGORIES: Record the appropriate alpha code in the category box.

	A–Adult Services/Family Type Home for Adults	L–This is a director or employee at legally exempt group child
	A–Adult Services/Family Type Home for Adults	care. (This category is only to be used by Enrollment Agencies).

	CCE–Child Care Current Employee	(fee required - see below) *
	CCZ–Child Care Prospective Volunteer/Consultant
	CCZ–Child Care Prospective Volunteer/Consultant	M–Director of a summer camp, overnight camp, day camp or
	CCS–Child Care Provider of Goods/Services	M–Director of a summer camp, overnight camp, day camp or
	CCS–Child Care Provider of Goods/Services	traveling day camp.
		traveling day camp.
	D–Prospective employee (Local DSS district - bill against	N–Applying for a license to operate a day care center. (To be
	reimbursement) **	submitted by authorized licensing agency only.)
		(fee required - see below) *
	F–Prospective/new employee other than day care employees.	P–Applying to be a family day care provider. (fee required - see
	(fee required - see below) *	below) * Provide address history for all household members 18-
	G–This is a provider or employee, at legally-exempt in-home child	years old or over.

	care who does not reside in the home. No checks required	Q–Applying to be group family day care provider.
	when provider is a legally-exempt relative-only in-home child	Q–Applying to be group family day care provider.
		(fee required - see below) * Provide address history for all
	care provider.
	care provider.	household members 18 years old or over.
		household members 18 years old or over.
	(This category is only to be used by Enrollment Agencies) (fee	R–Applying to be kinship foster parents.
	required - see below) *	R–Applying to be kinship foster parents.
	required - see below) *
		U–Universal Pre-K Teacher (fee required - see below)*
	I–This is a provider, at legally-exempt family child care. No checks	W–Applying to be foster parents or family care home providers.
	required when provider is a legally-exempt relative-only family
	child care provider. (This category is only to be used by	X–Applying to be adoptive parents pursuant to an application
	Enrollment Agencies) (fee required - see below) * For providers,	pending before the inquiring agency.
	include address history for all household members 18-years old	pending before the inquiring agency.
		Y–Prospective Day Care employee (fee required - see below) *
	or over who are not related in any way to all children in care.
		–Applying to be a Group Family Day Care Assistant.
		–Applying to be a Group Family Day Care Assistant.
		(fee required - see below) *
	J–Age 18 or Older Household Member (with no child care role)	Prospective employee of legally-exempt family child care (fee

		required-see below)*

AGENCY LIAISON: Record the name of the person to whom the response should be sent (cannot be the same as applicant or related to the applicant).

APPLICANT/HOUSEHOLD MEMBER AREA INSTRUCTIONS: This information is to be provided by the applicant/employee/ provider. (See front of form).

APPLICANT(S): -USE FIRST LINE (at least one person must be so designated)

MAIDEN NAME/ALTERNATIVE/AKA: MUST be completed for every applicant. Record ALL previous names used. Start with second line. Use as many lines as needed (one last name per line)

OTHER HOUSEHOLD MEMBERS: describe relationship to applicant, e.g., son, daughter, father, mother, friend, etc. on remaining lines

(ATTACH ADDITIONAL PAGE IF NECESSARY)

IF THERE ARE NO OTHER HOUSEHOLD MEMBERS, PLEASE CHECK BOX FOR NO OTHER HOUSEHOLD MEMBERS.

*Social Services Law 424-a(1)(f) requires the collection of a $25.00 fee for applicants for employment and applicants to be a child care provider. A certified check, postal or bank money order, teller's check, cashier's check or agency check made payable to "New York State Office of Children and Family Services" in the amount of twenty-five dollars, is to accompany the form. The check must also include the applicant's name and the agency code.

N.B.: a separate check must accompany each form.

**Social Services Law 424-a, allows local DSS to bill against their reimbursement the charge collected for screening prospective employees.

If you have questions, please call the SCR at 518-474-5297.

SUBMIT YOUR COMPLETED FORM, LDSS-3370, DCCS VERSION TO THE PERSON REFERENCED IN OCFS-6000 INCLUDE THE REQUIRED FEE FOR EACH APPLICANT FOR EMPLOYMENT/TO BE A CHILD CARE PROVIDER

LDSS-3370 (Rev. 12/2019) DCCS version

STAPLE TO LDSS-3370, DCCS version (IF NEEDED)

STATEWIDE CENTRAL REGISTER DATABASE CHECK FORM

ADDITIONAL PAGE

(Use only if the space on the form, LDSS-3370, DCCS version is not sufficient)

APPLICANT NAME:

Print clearly, all dates must be consecutive (month/year). Be sure to associate address histories with particular individuals.

PREVIOUS STREET ADDRESS

CITY

STATE

ZIP

FROM

(Mo/Yr)

LDSS-3370 (Rev. 12/2019) DCCS version

STAPLE TO LDSS-3370, DCCS version (IF NEEDED)

STATEWIDE CENTRAL REGISTER DATABASE CHECK FORM

ADDITIONAL PAGE

(Use only if the space on the form, LDSS-3370, DCCS version is not sufficient)

APPLICANT NAME:

Other Household Members are: (please print clearly):

IF THERE ARE NO OTHER HOUSEHOLD MEMBERS, PLEASE CHECK THIS BOX.

SCR USE	RELATIONSHIP	LAST NAME	FIRST NAME	SEX	DATE OF BIRTH
ONLY	TO APPLICANT			M/F	mm	dd	yyyy
				M
				F

				M
				F

				M
				F

				M
				F

				M
				F

				M
				F

				M
				F

				M
				F

				M
				F

				M
				F

				M
				F

				M
				F

				M
				F

				M
				F

				M
				F

				M
				F

				M
				F

				M
				F

				M
				F

				M
				F

				M
				F

				M
				F

				M
				F

				M
				F

				M
				F

				M
				F

				M
				F

				M
				F

↓ Ldss 3370 PDF

File Specs

Fact Name	Description
Form Purpose	The LDSS-3370 form is used to request a background check through the Statewide Central Register for individuals applying for roles related to child care and protection.
Required Information	All applicants must provide complete and legible information about themselves and all household members, including names, relationships, and addresses for the past 28 years.
Signature Requirements	Depending on the category, signatures may be required from the applicant and all household members aged 18 or older. Signatures must match the names listed on the form.
Governing Law	This form is governed by Section 424-a of the Social Services Law in New York State, which mandates the collection of background information for certain individuals.

Ldss 3370 - Usage Guidelines

Completing the LDSS-3370 form requires careful attention to detail. This form is essential for the Statewide Central Register Database Check. Once you have filled it out, you will submit it to the Statewide Central Register for processing. Ensure that all information is accurate and legible to avoid delays.

Agency Information:
- In the top left-hand box, enter the three-digit agency code.
- Next to the agency code, input the Resource I.D. (RID) or the Child Care Facility System (CCFS) Number if applicable.
- Fill in the Clearance Category letter code in the middle box.
- Provide a phone number with area code for the agency liaison.
- Leave the Request ID Box blank, as it is for SCR use only.
Agency Address Area:
- Write the full name of the agency, avoiding abbreviations.
- Include the name of the Agency Liaison, who cannot be the applicant or a relative.
- Complete the agency address, including street, city, state, and ZIP code.
Applicant Information:
- List the applicant’s name on the first line, followed by any maiden names or aliases on subsequent lines.
- Record all household members’ names, indicating their relationship to the applicant.
- Fill in the sex (M/F) and date of birth (mm/dd/yy) for each person listed.
Address Area:
- Provide the current address for the applicant and any household members 18 and older, listing all addresses for the last 28 years.
- Use complete addresses, including street name, number, and apartment number if applicable.
- If the applicant has lived abroad or served in the military, include that information as well.
Signature Area:
- For Adoption, Foster Care, and Family Day Care, have the applicant and all household members over 18 sign the form.
- Ensure all signatures match the names listed in the Applicant/Household Member Area.
- Each signature must be dated; the date cannot be more than six months old.

After completing the form, double-check all entries for accuracy and clarity. Once confirmed, mail the completed LDSS-3370 form to the Statewide Central Register at the provided address. If you need additional forms, follow the instructions for ordering more. For any questions, contact the SCR directly.

Your Questions, Answered

What is the LDSS-3370 form used for?

The LDSS-3370 form is used to conduct a Statewide Central Register Database Check. This check is necessary for individuals applying to work in child care settings, such as adoption, foster care, or family day care. The form helps ensure the safety of children by screening applicants for any history of child abuse or maltreatment.

Who needs to fill out the LDSS-3370 form?

The form must be completed by the applicant and all household members, both adults and children. This includes anyone living in the home, regardless of their relationship to the applicant. It is important to list everyone clearly to obtain accurate results.

What information is required on the form?

When completing the form, you will need to provide agency information, applicant details, and address history for the last 28 years. This includes names, relationships, dates of birth, and current and previous addresses. Ensure that all information is legible and complete, as incomplete forms will be returned for corrections.

How should I list household members on the form?

List all household members starting with the applicant's name. Include any maiden names or aliases on the following lines. For each person, indicate their relationship to the applicant, their sex, and their date of birth. If you have more members than space allows, you can attach an additional page, but do not use another LDSS-3370 form.

What if I have lived abroad or served in the military?

If you have lived outside the United States or served in the military, you should include this information on the form. Specify the country and the dates of your residence or service. This detail is important for a thorough background check.

Are signatures required on the form?

Yes, signatures are necessary. For adoption, foster care, and family day care categories, both the applicant and any household members aged 18 or older must sign. For other categories, only the applicant's signature is needed. Make sure all signatures match the names listed on the form.

What happens if the form is not filled out correctly?

If the LDSS-3370 form is incomplete or illegible, it will be returned to the agency for corrections. This can delay the processing of your request, so it is crucial to review the form carefully before submission.

How do I submit the completed LDSS-3370 form?

Once you have completed the form, mail it to the Statewide Central Register at P.O. Box 4480, Albany, NY 12204-0480. Make sure to send it to the correct address to avoid any delays in processing.

Where can I get more LDSS-3370 forms?

You can order additional LDSS-3370 forms by accessing the Request for Forms and Publications (OCFS-4627) online. Follow the links provided on the New York State Office of Children and Family Services website. If you encounter difficulties, you can also call their automated forms hotline for assistance.

Common mistakes

Illegible handwriting: If the information is not easily readable, it may be returned for corrections.
Incomplete information: Failing to provide all required details can lead to delays. Review the form thoroughly before submission.
Incorrect agency code: Ensure the three-digit agency code is accurate. Contact the licensing agency if unsure.
Missing applicant signatures: Signatures are necessary for all applicants and relevant household members. Omitting them can invalidate the form.
Wrong date formats: Dates must be filled in the mm/dd/yy format. Incorrect formats may cause confusion.
Not listing all household members: Include all adults and children, regardless of relation to the applicant. Missing names can lead to incomplete checks.
Providing PO Box addresses: Only physical addresses are accepted. PO Box numbers are not valid.
Using abbreviations: Write out the full agency name and avoid any abbreviations to ensure clarity.
Inconsistent names: Signatures must match the names listed on the form. Variations can cause issues.
Failure to attach supplemental pages: If more space is needed, use additional pages instead of another LDSS-3370 form.

Documents used along the form

The LDSS-3370 form is essential for conducting background checks through the Statewide Central Register. However, several other documents may accompany it to ensure thoroughness and compliance with regulations. Below is a list of commonly used forms and documents that often go hand-in-hand with the LDSS-3370.

OCFS-4627 Request for Forms and Publications: This form is used to request additional supplies of the LDSS-3370 and other related documents. It can be submitted via mail to the Office of Children and Family Services.
Supplemental Information Page: This page is attached to the LDSS-3370 when there is insufficient space to list all household members or addresses. It ensures that all necessary information is provided without omitting details.
Authorization for Release of Information: This document allows the agency to obtain necessary background information from other organizations or entities, streamlining the verification process.
Child Care Facility System (CCFS) Number Verification: This document confirms the CCFS number for daycare providers, ensuring compliance with licensing requirements.
Agency Liaison Contact Form: This form designates the agency liaison responsible for handling inquiries related to the LDSS-3370, ensuring clear communication between the agency and the Statewide Central Register.
Applicant's Consent Form: This form is necessary for the applicant's consent to conduct background checks. It outlines the purpose and scope of the checks being performed.
Proof of Identity Document: This document verifies the identity of the applicant or household members. It may include a driver's license or state-issued ID, which is crucial for accurate background checks.

Each of these documents plays a vital role in the background check process, ensuring that all necessary information is collected and verified. Properly completing and submitting these forms can help facilitate a smooth and efficient review process.

Similar forms

The LDSS-3370 form is similar to the Child Abuse and Neglect (CAN) Report. Both documents are used to gather essential information about individuals involved in childcare settings. The CAN Report focuses on allegations of abuse or neglect, while the LDSS-3370 specifically checks for previous reports of child abuse or maltreatment in the Statewide Central Register. Each form aims to ensure the safety of children by thoroughly vetting individuals who work or live in childcare environments.

Another document similar to the LDSS-3370 is the Foster Care Application. This application collects information about potential foster parents and their households. Like the LDSS-3370, it requires detailed demographic data about all household members, including relationships and history. The goal of both forms is to assess the suitability of individuals for caring for children, ensuring that all relevant background information is available for review.

The Adoption Application also bears similarities to the LDSS-3370 form. Both documents require comprehensive information about the applicant and their household. The Adoption Application specifically seeks to evaluate the applicant's fitness to adopt, while the LDSS-3370 focuses on any past child abuse allegations. Each form plays a critical role in safeguarding children by ensuring that potential caregivers have been thoroughly vetted.

The Criminal Background Check form is another document comparable to the LDSS-3370. This form is used to screen individuals for any criminal history that may disqualify them from working with children. Like the LDSS-3370, it requires accurate and complete information about the individual and their background. Both forms aim to protect children from potential harm by ensuring that caregivers have a clean record.

The Employment Application for childcare positions shares similarities with the LDSS-3370 form as well. Both documents require detailed information about the applicant’s history and qualifications. While the Employment Application focuses on the applicant's professional background, the LDSS-3370 checks for any history of child abuse or maltreatment. Both forms are essential for ensuring the safety of children in care settings.

The Home Study Report is another document that aligns with the LDSS-3370. This report assesses the living conditions and suitability of a household for fostering or adopting children. It requires detailed information about the household, similar to what is required in the LDSS-3370. Both documents serve to evaluate the environment in which a child may live, ensuring it is safe and nurturing.

The Licensing Application for daycare providers is akin to the LDSS-3370 form. This application requires information about the daycare facility and its staff, similar to how the LDSS-3370 gathers information about individuals involved in childcare. Both forms aim to ensure compliance with state regulations and to promote the safety and well-being of children in care.

The Volunteer Application for childcare programs also resembles the LDSS-3370. This application collects information about individuals who wish to volunteer in childcare settings. Like the LDSS-3370, it requires background information to assess the volunteer's suitability. Both documents aim to ensure that children are protected from individuals who may pose a risk.

Finally, the Statewide Central Register Database Check for employees in educational settings is similar to the LDSS-3370. This document checks for any history of child abuse or maltreatment among school staff. Like the LDSS-3370, it is crucial for maintaining a safe environment for children. Both forms work together to ensure that individuals working with children have been thoroughly vetted for any potential risks.

Dos and Don'ts

When completing the LDSS-3370 form, there are several important guidelines to follow. Here is a list of things to do and avoid:

Do ensure all information is clearly printed or typed to facilitate accurate data entry.
Do include the three-digit agency code and Resource ID in the appropriate boxes at the top of the form.
Do list all household members, regardless of their relationship to the applicant, in the designated area.
Do provide complete addresses for the last 28 years, including street numbers and apartment details.
Do check that all signatures correspond to the names listed in the Applicant/Household Member area.
Don't abbreviate any names of the agency or household members; use full names instead.
Don't forget to date all signatures; forms with signatures dated more than six months old will not be accepted.

Following these guidelines can help ensure that the form is processed smoothly and efficiently.

Misconceptions

Misconceptions about the LDSS-3370 form can lead to errors in the application process. Understanding these misconceptions is crucial for accurate submissions. Below are eight common misconceptions along with clarifications:

Only the applicant needs to be listed. All household members, including adults and children, must be included on the form, regardless of their relationship to the applicant.
Any signature is acceptable. Signatures must match the names recorded on the form. For instance, if the name is recorded as Mary Smith, she cannot sign as Mary Ann Smith.
Incomplete forms can still be submitted. The form must be complete and legible. Incomplete submissions will be returned for corrections.
Previous addresses are optional. For certain categories, a complete address history for the last 28 years is required, particularly for applicants and household members over 18.
Aliases and maiden names are not necessary. All previous names, including maiden names and aliases, must be provided for each applicant.
Post Office Box addresses are acceptable. The form requires complete street addresses. Post Office Box numbers cannot be used.
There is no need for a contact number. A phone number must be included for the agency liaison to facilitate communication if needed.
Only one copy of the form is needed. If additional pages are required for address history, they must be attached to the LDSS-3370 form rather than using a new copy of the form.

Addressing these misconceptions can help ensure that the LDSS-3370 form is completed correctly, reducing the risk of delays in processing.

Key takeaways

When filling out and using the LDSS-3370 form, it is essential to follow specific guidelines to ensure accuracy and compliance. Here are some key takeaways:

Legibility is Crucial: All information on the form must be clear and easy to read. Illegible forms will be returned for corrections.
Complete Agency Information: Include the three-digit agency code, Resource ID, and the agency liaison's contact information at the top of the form.
List All Household Members: Include all adults and children living in the household, regardless of their relationship to the applicant. Use the proper format for names.
Accurate Address History: Provide a complete address history for the last 28 years for the applicant and any household member over 18, where applicable.
Signatures Matter: Ensure all required signatures are obtained. Signatures must match the names listed on the form and be dated appropriately.
Use Supplemental Pages Wisely: If additional space is needed for addresses or household members, attach supplemental pages rather than using another LDSS-3370 form.
Mailing Instructions: Send the completed form to the designated address for the Statewide Central Register to ensure it is processed correctly.