Monday, January 14, 2008

cps records request form

PS-072-2 (3-06)
Division of Children, Youth and Families
(Person or agent of a person who is the subject of CPS information)
Child Protective Services (CPS) records are confidential and can be released only to those individuals and agencies permitted by state and federal law. This form is to be used by a person or agent of a person who is the subject of CPS information pursuant to A.R.S. § 8-807(E). You may be asked to provide information to verify your status as a person or agent of a person who is the subject of CPS information. The Department of Economic Security, (DES) will strike out (redact) all personally identifiable information including: the identity of the reporting person, children, parents, relatives, foster parents, persons or entities with whom children reside and any other persons whose life or safety may be endangered by the disclosure. DES is not required to release records that have previously released in the normal course of records distribution in the juvenile court proceeding, without the necessity being demonstrated. You must provide information as completely and accurately as possible to facilitate a record search and processing.
Requester’s Name (Last, First, M.I.) Case Relationship (parent, attorney, agent)
Reason for Request (dependency or termination hearing) Court Number Hearing Date
Record Distribution
Pick up
Phone No.
Work: ( ) Home: ( )
Child’s Mother’s Name Social Security Number Date of Birth
Child’s Father’s Name Social Security Number Date of Birth
Other Specific Information Known
I certify that I am the person indicated above and understand that all information I receive is confidential and shall not be further disclosed.
Signature of Person Requesting Information Date
Date Request Received Number of Pages Redacting Time Copying Time
Name of Person Redacting Position of Person Redacting Hourly Wage Phone No.
Name of Person Copying Position of Person Copying Hourly Wage Phone No.
Records Were:
Mailed Picked Up Date:
Was Request Denied (If yes reason)
Coordinator’s Signature Date:

1 comment:

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I am an open minded, very liberal, opinionated, brutally honest, woman who is not afraid to speak her mind., but always keeping in mind that there is a time and a place for everything. I consider my self to be of decent morals, I do not lie, I don’t steal. I believe that, I may not agree with what someone may be saying, but I will stand up for their right to say it. I am a violinist, a writer, a mom. and very soon to be a grandma. I have been told that I am ruthless at times, and often to others I seem untouchable, or maybe distant. I think I have even been called a snob a time or two. I don’t necessarily judge anyone unless they give me a reason to. You want to act like an idiot, in front of me. Then I will assume you are an idiot and wont waste my time, effort or energy on you. I am pro choice and pro life, I believe it should be up to the individual, not the government or a man. I believe that woman have got it rough right from the get go, and always have so much against them before they even began. But, I believe that we as woman can and do still rise above.

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