OCFS Day Care Center and School Authorized Person Designation Form
This form allows a designated Authorized Person to request a Staff Exclusion List (SEL) check from the Justice Center. It ensures compliance with Social Services Law and confidentiality requirements. Required for programs hiring employees, volunteers, consultants, or residents.
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How do I fill this out?
To complete this form, follow the provided instructions in each section. Ensure the Authorized Person and Director's signatures are obtained. Submit the completed form to the Justice Center.
How to fill out the OCFS Day Care Center and School Authorized Person Designation Form?
1
Complete all parts of the form.
2
Authorized Person signs Part 1 and Director signs Part 2.
3
Scan or fax the completed form to the Justice Center.
4
Provide necessary business and licensing information.
5
Ensure all signatories understand their responsibilities.
Who needs the OCFS Day Care Center and School Authorized Person Designation Form?
1
Day care centers requiring SEL checks for new hires.
2
Programs needing to ensure compliance with Social Services Law.
3
Schools hiring staff who will have substantial contact with children.
4
Consultants working in child care programs.
5
Volunteers participating in day care or after-school programs.
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What are the instructions for submitting this form?
Submit the completed form to the Justice Center's CBC Unit via email at cbc@JusticeCenter.ny.gov or fax it to 518-549-0464. Ensure all sections are properly filled and required signatures are obtained. A scanned copy of the form is acceptable for submission. For advice, verify the form for accuracy and completeness to avoid delays in processing.
What are the important dates for this form in 2024 and 2025?
Ensure submission by relevant deadlines each year. Check with the Justice Center for specific dates.
What is the purpose of this form?
The purpose of this form is to designate an Authorized Person who can request Staff Exclusion List (SEL) checks on behalf of a day care center or school program. This ensures compliance with Social Services Law and reinforces the program's commitment to child safety. By following the proper procedures, programs can safeguard their environments and protect children from individuals on the SEL.
Tell me about this form and its components and fields line-by-line.
- 1. Authorized Person's Last Name: Enter the last name of the Authorized Person.
- 2. First Name and M.I.: Enter the first name and middle initial of the Authorized Person.
- 3. Business Name: Provide the name of the business or program.
- 4. Business Email Address: Enter the email address for business correspondence.
- 5. Business Phone Number: Provide a contact phone number for the business.
- 6. Business Address: Enter the street address, city, state, and zip code of the business.
- 7. License/Facility ID Number: Provide the OCFS DCC or SACC license/facility ID number.
- 8. Authorized Person's Signature: The Authorized Person must sign and date the form.
- 9. Director's Signature: The Director must approve and sign the designation of the Authorized Person.
What happens if I fail to submit this form?
Failure to submit this form may result in non-compliance with Social Services Law and potential penalties.
- Non-Compliance Penalties: Programs may face legal and financial penalties for non-compliance.
- Inability to Request SEL Checks: Without submission, programs cannot request SEL checks for new hires.
- Risk to Child Safety: Failure to conduct SEL checks can endanger children under the program's care.
How do I know when to use this form?
- 1. New Hires: Request SEL checks for new employees.
- 2. Volunteers: Conduct SEL checks for volunteer staff.
- 3. Consultants: Ensure consultants undergo SEL checks.
- 4. Program Compliance: Maintain compliance with Social Services Law.
- 5. Safety Assurance: Reinforce child safety by vetting individuals interacting with children.
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What information is required to complete this form?
You need to provide business details, license information, and authorized signatures.
Who needs to sign this form?
The Authorized Person must sign Part 1 and the Director must sign Part 2.
Where do I submit the completed form?
Submit the form to the Justice Center via email or fax.
Can I fill out this form online?
Yes, you can fill out and edit the form online using PrintFriendly's PDF editor.
What does this form authorize?
The form designates an Authorized Person to request SEL checks for a program.
Is the form compliant with Social Services Law?
Yes, the form ensures compliance with Social Services Law and confidentiality requirements.
Do I need to inform applicants about the SEL check?
Yes, applicants must be informed about the SEL check and its potential impact on employment.
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