Child Abuse History Clearance Forms

The information below is related to Background Checks/Certifications for:

  • Pennsylvania Child Abuse History Clearances (CY113)
  • Pennsylvania Criminal Record Checks for Employment (SP4-164)
  • Pennsylvania Criminal Record Checks for Volunteers (SP4-164A)
  • Federal Bureau of Investigations (FBI) Criminal Background Checks


Requirements for clearances, effective July 1, 2015:

  • Clearances that have been obtained in Pennsylvania within the past 60 months are acceptable and considered “current." The concept of “obtained within the past three months” has gone away.
  • Clearances obtained for employment purposes are acceptable for volunteer purposes.
  • Clearances obtained for volunteer purposes are NOT acceptable for employment purposes.
  • New/potential employees must:
    • Submit current clearances before starting employment or show proof of applying for clearances and sign a disclosure statement before starting employment on a provisional basis.
  • Employees presenting clearances within the past 60 months need to affirm that nothing has changed since obtaining the clearances. (The updated disclosure statement for provisional employment is used for this purpose.)
  • The provisional hiring period is still 90 days.
  • Employees are required to report changes in clearances status within 72 hours.
  • Updated clearances must be obtained as follows:
    • If the clearances were obtained prior to Dec. 31, 2014 and are more than 60 months old: by Dec. 31, 2015.
    • If the clearances were obtained prior to Dec. 31, 2014 and are less than 60 months old: by 60 months from the date of the oldest clearance.
      • Example: For a child abuse clearance obtained Jan. 1, 2014, Pennsylvania State Police clearance obtained Feb. 1, 2014 and FBI fingerprint clearance obtained March 1, 2014, updated clearances for all three must be obtained by Jan.1, 2019.
  • A Child Abuse Clearance can be obtained through the Child Welfare Portal.
  • A Pennsylvania State Police Request for Criminal History Check can be obtained here.
  • A FBI Fingerprint Criminal History Clearance is obtained by registering on the Cogent, Inc. website.

For more information, visit Keep Kids Safe.


Child Abuse History Clearance Online:

Creating an account and submitting your clearance application online will give you immediate access to your results or the status of your results if your results cannot be processed immediately.

Organizations who want to set up business accounts must first register for a Business Partner User account using the “Organization Account Access” link on the Child Welfare Portal. Organization accounts will allow businesses and organizations to purchase child abuse history clearance payment codes and distribute those codes to applicants. When an applicant uses a code given to them by an organization, the organization will have access to the applicant’s child abuse history clearance results once those results are processed.


Paper submissions of the Pennsylvania Child Abuse History Clearance application will still be accepted for anyone who may not have access to the internet. Submit paper applications to:

ChildLine and Abuse Registry
Pennsylvania Department of Human Services
PO Box 8170
Harrisburg, PA 17105-8170

  1. The instructions for how to complete the Pennsylvania Child Abuse History Clearance application are now included on the last page of the application and can be printed for easy reference when completing the application. Failure to comply with the instructions that are attached to the application will cause considerable delay in processing the results.
  2. Applicants can now type their information directly onto the application or the information can be hand written onto the application.
  3. If the information is typed directly onto the application, the information will NOT be able to be saved on a computer unless the computer has a licensed version of the acrobat adobe software. Therefore, please be sure to print the completed application before closing the document so that the information typed on the application is not lost.
  4. If you have trouble accessing the application you may need to download the latest version of Adobe Reader, which is available free on the internet.

NOTE: ALL information that has been entered directly onto the application will be lost if you close the application prior to printing it (if your computer does not have a licensed version of the Acrobat Adobe software).

Once the application is received in the ChildLine and Abuse Registry’s Verification Unit, the results of the Pennsylvania Child Abuse History Clearance will be mailed to the applicant’s address that was noted on the application within 14 days from the date that the application is received in the ChildLine Verification Unit.

CY113 form - English Child Abuse Clearance

CY113 form - Spanish Child Abuse Clearance

An applicant can request that a Pennsylvania Child Abuse History Certification result be mailed to an organization by completing a Consent Release of Information Authorization Form. Both the applicant and organization must sign the form and the form must be attached to a paper Child Abuse History Certification application submitted via mail in order for the results to be released to the organization. Older versions of the Consent Release Form without a signature line for the organization will continue to be accepted until May 31, 2016. After this date, Consent Release Forms without a signature line for organizations will no longer be accepted and the certification result will be returned directly to the applicant, not the organization.

Note: Results cannot be sent to someone other than the applicant if applying for a Child Abuse History Certification electronically via the online link above. If an organization pays the application fee, they will have the ability to access an applicant’s results online if they set up a business account and provide the pre-paid code to the applicant.

CY 999 -Consent/Release of Information Authorization Form

For questions related to the Pennsylvania Child Abuse History Clearance, please contact the ChildLine Verification Unit at 717-783-6211 or toll free at 1-877-371-5422.


There are two methods of requesting a Criminal Record.

  1. Online Request
    The Pennsylvania State Police have established a web-based computer application called “Pennsylvania Access To Criminal History,” (PATCH). 
  2. Submitting a Request Form
    Download the Criminal History Request Form - SP4-164 (Updated 7/2015)
    Download the Criminal History Request Form: Volunteer Only- SP4-164A (Updated 7/2015)
    Download the Individual Access and Review Request Form - SP4-170 (Updated 7/2015)

Applicants can also go to the Pennsylvania Access To Criminal History website and apply for their criminal record check online with the Pennsylvania State Police at:

If you have questions about the Pennsylvania State Police Request for Criminal Record Checks form for employment (SP4 164) or to volunteer (SP4-164A), please call: (717) 783-9973 or toll free 1-888-783-7972.


The Pennsylvania Department of Human Services is utilizing Cogent Systems to process fingerprint-based FBI criminal background checks. The fingerprint based background check is a multiple step process. For more information and to begin the registration process, go to For question about your FBI Clearance, please contact the FBI/Adam Walsh Unit at 717-783-6211 or 1-877-371-5422.

*The Pennsylvania Department of Education also utilizes Cogent Systems to process finger print based FBI criminal background checks for prospective employees of public and private schools. Under Act 114 of 2006, ALL prospective school employees, school contractors and student teachers are to use the Pennsylvania Department of Education system. This includes but is not limited to: Teachers, School Administrators, Substitute Teachers, Teaching Assistants, PIAA Sports Officials, School Bus Drivers, and Student Teachers. Applicants may register online at:

For more information regarding Act 114, and background check requirements for public schools, private schools and student teachers go to the Pennsylvania Department of Education website or contact the Pennsylvania Department of Education at RA-PDE-SchoolService@pa.Gov.

If you have questions about the FBI Cards for School Employees (FD 258), please call: (717) 783-3750.