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New Jersey Department of Children and Families Policy Manual

 

Manual:

CP&P

Child Protection and Permanency

Effective Date:

Volume:

X

Forms

Chapter:

A

Forms

10-24-2011

Subchapter:

1

Forms

Issuance:

4.6

CP&P Form 4-6, Domestic Violence Central Registry Check Form

 

 

Click here to view or print CP&P Form 4-6, Domestic Violence Central Registry Check Form.

 

Instructions            

 

PURPOSE AND USE:

 

The purpose of CP&P Form 4-6, Domestic Violence Central Registry Check Form, is to:

 

      Enable the Worker to obtain information regarding whether any Kinship Legal Guardianship (KLG) applicant(s) and adult household member(s) in the applicant's home have a history of domestic violence; and

 

      Report affirmative (history found) results to the appropriate court.

 

The Kinship Legal Guardianship Act, N.J.S.A. 3B:12A-5, requires that a Kinship Legal Guardianship Assessment be submitted to the Court, upon request, to assist the judge in determining the suitability of a caregiver, a person with a biological or legal relationship to the child or family friend, to become the child's legal guardian.

 

The Assessment may be completed when:

 

      The child has been in out-of-home placement living with a caregiver who has been providing care and support for the child for at least 12 consecutive months,

 

      Parental incapacity has prevented the parent(s) from providing care and support for the child, and

 

      The Division has determined that return home or adoption is not likely or feasible.

 

This assessment includes the results from Domestic Violence Central Registry checks for the caregiver(s) and all adult household member(s).

 

The CP&P Form 4-6 is used in conjunction with CP&P Form 4-5, Kinship Legal Guardianship Assessment, and CP&P Form 4-5a, Division of Child Protection and Permanency Certification of Completed Background Checks for Kinship Legal Guardianship.

 

Each KLG applicant and household member, 18 years of age and older, provides identifying information on a form and certifies that the information given is accurate and complete.

 

The Office of Licensing (OOL) within the Department of Children and Families (DCF) provides the results, either affirmative (history found) or negative (no history found), of the Domestic Violence Central Registry check to the CP&P Worker.

 

INSTRUCTIONS FOR COMPLETING THE FORM

 

The CP&P Worker completes the enclosed box on page 1, entitled "FOR DIVISION OF CHILD PROTECTION AND PERMANENCY USE ONLY."  Each KLG applicant and household member completes the remainder of page 1 and the top of page 2.  The enclosed box on the bottom of page 2, entitled "FOR OFFICE OF LICENSING USE ONLY," is completed by OOL staff.

 

1.    The CP&P Worker supplies the information in the enclosed box on page 1. If there is more than one KLG applicant, complete a separate form for each applicant.  Enter:

 

      Name of relative/family friend caregiver seeking KLG

 

      Name of the child for whom the applicant is seeking legal guardianship

 

      Name of the CP&P Worker requesting the results and to whom the results are to be sent

 

      Name of the Local Office and address including street or box number, city, state, and zip code

 

2.    The applicant or household member completes the remainder of the form on page 1 and the top of page 2 providing:

 

      Identifying information, including full name, previous names, date of name change if applicable, address, date of birth, race, sex, and social security number

 

      Previous addresses since 1981 and the dates he or she resided there

 

      Whether he or she is an applicant or household member and if a household member, the name of the applicant

 

The applicant or household member reads, signs, and dates the form certifying that the information provided is accurate and returns the completed form to the Worker at the Local Office designated on the front of the form.

 

3.    Upon receipt of the completed CP&P Form 4-6 form(s), the CP&P Worker submits the form(s) to OOL.

 

4.    An OOL staff member checks the Domestic Violence Central Registry and provides the results of the check to the CP&P Worker on the submitted CP&P Form 4-6 in the box noted "FOR OFFICE OF LICENSING USE ONLY."  In the designated box, the OOL staff member stamps the date the form was received and stamps either "Record Found, Office of Licensing, Department of Children and Families" or "No Record Found, Office of Licensing, Department of Children and Families."  He or she then initials the form in the designated box and returns it to the sending CP&P Worker.

 

5.    Upon receipt of the results from OOL, the Worker completes CP&P Forms 4-5 and 4-5a as appropriate.  See Instructions for CP&P Forms 4-5 and 4-5a.

 

DISTRIBUTION

 

Original         -            If the results are affirmative, attach the completed CP&P Form 4-6 form(s) to the corresponding CP&P Form 4-5 and 4-5a and send to the appropriate County Superior Court of New Jersey, Chancery Division-Family Part

 

Original         -            If the results are negative, file in the child's case record

 

Copy             -            If the results are affirmative, file copies of all the completed forms in the child's case record and another set of copies in the relative/family friend caregiver record

 

Copy             -            If the results are negative, file in the relative/family friend Caregiver case record