CPS Background Clearance Packet

This packet contains the following documents:

  1. Instructions for submitting a CPS/Adam Walsh Background Clearance Request;
  2. The Consent for Release of Information CPS/Adam Walsh Background Clearance Request; and
  3. The mailing and email address for the Local Departments of Social Services (LDSS).

Instructions for submitting a CPS/Adam Walsh Background Clearance Request Clearance Request Requirements:

  • A separate request is required for each individual whose name is to be searched.
  • Provide proof of identity to the Notary Public before you sign Part IV. The Notary’s signature and seal is required on all forms.* Legible photocopies will be accepted. The request form expires 60 days from the date of the applicant’s signature.

    *Requests being made by a State’s Department of Social Services does not require a Notary signature/seal.

  • A request form must be legible and completed in its entirety.
  • If you have been issued a Social Security Number (SSN), you MUST provide it to ensure a thorough search can be conducted.
  • If the applicant is under 16 years of age, a parent/guardian must authorize the form and it must be notarized.