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Three forms are required for fingerprint-based criminal background checks for adoptive parents and all adults living in an adoptive home.

Please Note: Not all forms are compatible with Mac programs.
 

Instructions:
How to Complete Forms and Submit a Fingerprint-based Criminal Background Check


Form 1 
Personal Authorization for Criminal History Record Information Inquiry (SFN 829)
(This form must be typed)

Additional Address History
(Use as needed and attach along with SFN 829)


Form 2
Criminal History Record Check Request Form (SFN 60688)
OR -
Adoption Home Assessment Update (BCI only - SFN 60688)
(This form must be typed; Signature must be handwritten)


Form 3
Fingerprint Identity Verification (SFN 836)
(Print a blank copy of this form; not required for home assessment updates)

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All fees for adoption background checks must be paid by the applicant, to include any fees assessed by other states or tribal court/child welfare agencies. All fees must be paid with a check or money order payable to ND Department of Health and Human Services (ND DHHS). Current background check fee is $41.25. Spirit Lake Nation - $30, Standing Rock Sioux - $25, Three Affiliated Tribes $10, Turtle Mountain Band Chippewa - $10, Sisseton-Wahpeton - $20.

If you have lived outside of North Dakota during the past five years, click on each state you have lived in (below) to see if you need to:

  • Complete additional out-of-state authorization forms for each state you have lived in,
  • Provide a copy of a valid photo ID or a copy of your social security card, and/or
  • Provide an extra set of fingerprint cards (must obtained from a law enforcement agency or an authorized third-party fingerprinting agency)

If any of the above are required, they must be mailed to the Bismarck office – DO NOT send anything directly to other states.

Individual State Background Check Forms

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Individual State Background Check Forms

Select from the list below. PLEASE READ ALL INSTRUCTIONS CAREFULLY!

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Alabama / Alaska / Arizona / Arkansas

Alabama

The signature on the form below must be witnessed.

Child Protective Services form 


Alaska

Child Protective Services form 


Arizona

Child Protective Services form 


Arkansas

  • Complete the form below - notary not necessary.
  • Due to their requirements, a second form will be generated by the CBCU and it will be emailed directly to you.
  • The online-generated form DOES require a notary.
  • Mail the completed form to the CBCU.
  • Please Do NOT mail it to Arkansas.

Child Protective Services form 

California / Colorado / Connecticut

California

  • $15 processing fee (make payable to ND DHHS)

  • No forms are required.


Colorado

  • The form below must be typed. Photo ID required.
  • $35 processing fee (make payable to ND DHS)

Child Protective Services form


Connecticut

Child Protective Services form 

Delaware / Florida / Georgia / Hawaii

Delaware

Idaho / Illinois / Indiana / Iowa

Idaho

$20 processing fee (make payable to ND DHHS)

Child Protective Services form (2.61mb pdf)


Illinois

Child Protective Services form


Indiana

  • Online form required.
  • You will receive email instructions upon the department initiating a registry search.

Iowa

No forms are required.

Kansas / Kentucky / Louisiana

Kansas

Child Protective Services form 


Kentucky

A witness signature is required.

Child Protection Services form


Louisiana

The form below requires a photo ID.

Child Protective Services form 

Maine / Maryland / Massachusetts / Michigan

Maine

  • Complete only if you are 18 yrs old or older
  • This form CANNOT BE TYPED
  • $15 processing fee (make checks payable to ND DHHS)

Child Protective Services form 


Maryland

The form below must be typed. The signature must be notarized.

Child Protective Services form 


Massachusetts

Child Protective Services form


Michigan

A copy of a valid photo ID is required.

Child Protective Services form 

Minnesota / Mississippi / Missouri / Montana

Minnesota

$20 processing fee (make payable to ND DHHS)

Child Protective Services form (242kb pdf)


Mississippi

  • Online form required.
  • You will receive email instructions upon the department initiating a registry search.

Missouri

No additional form is required.


Montana

The signature on the form below must be notarized.

Child Protective Services form (74kb pdf)

Nebraska / Nevada / New Hampshire / New Jersey

Nebraska

  • The signature on the form below must be notarized.
  • If the applicant is not 19 years old or older, the applicant's parent or guardian must sign the form.
  • $2.50 processing fee (make payable to ND DHHS)

Child Protective Services form 


Nevada

The form below requires a photo ID, DO NOT NOTARIZE.

Child Protective Services form 


New Hampshire

The signature on the form below must be notarized.

Child Protective Services form 


New Jersey

Child Protective Services form 

New Mexico / New York / North Carolina

New Mexico

The form below must be typed. The signature must be notarized.

Child Protective Services form 


New York

The signature on the form below must be notarized.

Child Protective Services form 


North Carolina

The form below must be typed and requires a copy of a valid photo ID.

Child Protective Services form 

Ohio / Oklahoma / Oregon

Ohio

  • Form below must be typed.
  • Requires a copy of a valid photo ID and a copy of the applicant's social security card.
  • Results will be mailed to the applicant.
  • Applicant must forward them to the Criminal Background Check Unit in Bismarck.

Child Protective Services form (138kb pdf)


Oklahoma

Does not maintain a public registry.


Oregon

The form below must be typed.

Child Protective Services form (837kb Word doc)

Pennsylvania / Rhode Island / South Carolina / South Dakota

Pennsylvania

$13 processing fee (make payable to ND DHHS)

Child Protective Services form


Rhode Island

No forms are required.


South Carolina

  • You will receive email instructions after the department receives your background check request.

South Dakota

The signature on the form below must be notarized.

Child Protective Services form (81kb pdf)

Tennessee / Texas / Utah / Vermont / Virginia

Tennessee

No forms are required.


Texas

The signature on the form below must be notarized.

Child Protective Services form (509kb pdf)


Utah

The form below requires a photo ID.

Child Protective Services form (1.17mb pdf)


Vermont

No forms are required.


Virginia

  • You will receive email instructions after the department receives your background check request.
  • $10 processing fee (make payable to ND DHHS)
Washington / Washington, D.C. / West Virginia / Wisconsin / Wyoming

Washington

  • The form below must be typed.
  • $20 processing fee (make payable to ND DHHS)

Child Protective Services form (166kb pdf)


Washington, D.C.

  • The signature on the form below must be notarized.
  • The form requires full 18 years of address history.

Child Protective Services form (494kb pdf)


West Virginia

Child Protective Services form


Wisconsin

No forms are required.


Wyoming

Instructions will be emailed to the applicant.

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Contact Information

Criminal Background Check Unit
600 E. Boulevard Avenue, Department 325
Bismarck, ND 58505-0250
Phone: (701) 328-7575
Toll-Free: (800) 472-2622, 711 (TTY)
Fax: (701) 328-0358
Email: dhscfscbc@nd.gov