Table 5700-1 Criminal History Record Information Release Authorization Forms
Form Number | Title | How to Obtain: |
DSSP 256 | Criminal History Record Information Request Form (eff. 7/15/16) | Department of Safety Division of State Police - Criminal Records Unit (603) 223-3867 33 Hazen Drive Concord, NH 03305 |
DSSP 371 | DHHS/DCYF Relative Criminal Check Only (eff. 7/15/16) | www.dhhs.nh.gov Divisions/Offices; Division for Children, Youth and Families - Foster Care and Adoption (603) 271-4440 129 Pleasant Street, Concord, NH 03301 |
DSSP 372 | License Exempt Child Care Form NH RSA 170-E:3-a (eff. 10/1/16) | www.dhhs.nh.gov Divisions/Offices; Office of Operations Support - Child Care Licensing Unit (603) 271-9025 129 Pleasant Street, Concord, NH 03301 |
DSSP 373 | Applicants to Practice Medicine NH RSA 329:11-a (eff. 10/1/16) | Office of Professional Licensure and Certification - Division of Health Professionals (603) 271-4728, 121 South Fruit Street, Suite 301, Concord, NH 03301 |
DSSP 374 | Applicants to Physician Assistants RSA 328-d:3-a (eff. 10/1/16) | Office of Professional Licensure and Certification - Division of Health Professionals (603) 271-4728, 121 South Fruit Street, Suite 301, Concord, NH 03301 |
DSSP 375 | BDS Area Agencies or Community Mental Health Centers (eff. 7/15/16) | www.dhhs.nh.gov Divisions/Offices; Division of Community Based Care Services - Bureau of Behavioral Health (603) 271-5007 105 Pleasant Street, Concord, NH 03301 |
DSSP 376 | TANF Requests for Child Care Form NH RSA 170-E:7, II (eff. 7/15/16) | www.dhhs.nh.gov Divisions/Offices; Division of Family Assistance - Temporary Assistance for Needy Families (603) 271-9700 129 Pleasant Street, Concord, NH 03301 |
DSSP 377 | New Applicant - Adoptive Parents Form NH RSA 170-B:18 (eff. 10/1/16) | www.dhhs.nh.gov Divisions/Offices; Division for Children, Youth and Families - Foster Care and Adoption (603) 271-4440 129 Pleasant Street, Concord, NH 03301 |
DSSP 378 | Background Check Request of Alcohol and Other Drug Use Counselors NH RSA 330-C (eff. 10/1/16) | www.oplc.nh.gov Office of Professional Licensure and Certification - Division of Health Professionals (603) 271-6761, 121 South Fruit Street, Concord, NH 03301 |
DSSP 380 | Driver Education Instructors NH RSA 263:44-b, II (eff. 10/1/16) | Department of Safety Division of Motor Vehicles - Driver Education (603) 227-4075 23 Hazen Drive Concord, NH 03305 |
DSSP 381 | Child Day Care NH RSA 170-E:7, II - Child Care Institutions RSA 170-E:29-a:II (eff. 02/20/15) | www.dhhs.nh.gov Divisions/Offices; Office of Operations Support - Child Care Licensing Unit (603) 271-9025 129 Pleasant Street, Concord, NH 03301 |
DSSP 382 | School Employee/Volunteer Criminal History Record Check RSA 189:13-a (eff. 10/1/16) | Department of Safety Division of State Police - Criminal Records Unit (603) 223-3867 33 Hazen Drive Concord, NH 03305 |
DSSP 383 | County Employee Criminal History Background Check NH RSA 28:10-c (eff. 10/1/16) | Counties Select Specific County |
DSSP 384 | DCYF Personnel (eff. 7/15/16) | www.dhhs.nh.gov Divisions/Offices; Office of the Commissioner - Human Resources (603) 271-9344 129 Pleasant Street, Concord, NH 03301 |
DSSP 385 | DHHS Area Agencies (eff. 7/15/16) | www.dhhs.nh.gov Divisions/Offices; Division of Community Based Care Services - Bureau of Developmental Services (603) 271-5133, 105 Pleasant Street, Concord, NH 03301 |
DSSP 386 | Department of Safety Employees NH RSA 21-P:15-c (7/15/16) | Department of Safety Division of Administration (603) 223-8000 33 Hazen Drive Concord, NH 03305 |
DSSP 387 | Board of Nursing NH RSA 326-b:15 (eff. 10/1/16) | www.oplc.nh.gov Office of Professional Licensure and Certification - Division of Health Professionals (603) 271-2323, 121 South Fruit Street, Concord, NH 03301 |
DSSP 388 | Renewal - Foster Parents Form NH RSA 170-E:29 (eff. 7/15/16) | www.dhhs.nh.gov Divisions/Offices; Division for Children, Youth and Families - Foster Care and Adoption (603) 271-4440 129 Pleasant Street, Concord, NH 03301 |
DSSP 389 | New Applicant - Foster Parents Form NH RSA 170-E:29 (eff. 7/15/16) | www.dhhs.nh.gov Divisions/Offices; Division for Children, Youth and Families - Foster Care and Adoption (603) 271-4440 129 Pleasant Street, Concord, NH 03301 |
DSSP 390 | Hawkers, Peddlers, and Vendors Background Checks RSA 31:102-a & b (eff. 10/1/16) | Select Specific Municipality |
DSSP 391 | Municipal Employee/Volunteer Candidate Background Checks NH RSA 41:9-b (eff. 10/1/16) | Select Specific Municipality |
DSSP 392 | Licensing of Game Operators NH RSA 287-D:12 (eff. 10/1/16) | (603)271-3391 14 Integra Drive, Concord, NH 03301 |
DSSP 393 | Real Estate Appraisers Board NH RSA 310-B:6-a (eff. 10/1/16) | www.oplc.nh.gov Office of Professional Licensure and Certification - Division of Technical Professions (603) 271-2219, 121 South Fruit Street, Concord, NH 03301 |
DSSP 394 | Serve America Act Employees or Volunteers (eff. 10/1/16) | Provided to Applicant by Specific Employer |
DSSP 406 | Renewal - Adoptive Parents Form NH RSA 170-E:29 (eff. 7/15/16) | www.dhhs.nh.gov Divisions/Offices; Division for Children, Youth and Families - Foster Care and Adoption (603) 271-4440 129 Pleasant Street, Concord, NH 03301 |
DSSP 407 | Child Day Care RSA 170-E:7, II-Child Care Institutions RSA 170-E:29-a, II (eff. 7/15/16) | www.dhhs.nh.gov Divisions/Offices; Office of Operations Support - Child Care Licensing Unit (603) 271-9025 129 Pleasant Street, Concord, NH 03301 |
DSSP 408 | Consumer Reporting Agency (eff. 7/15/16) | Provided to Applicant by Specific Employer |
DSSP 409 | DCYF Intern/Volunteer Criminal Check Only (eff. 7/15/16) | www.dhhs.nh.gov Divisions/Offices; Division for Children, Youth and Families - Foster Care and Adoption (603) 271-4440 129 Pleasant Street, Concord, NH 03301 |
DSSP 410 | DHHS-DCYF Behavioral Health Provider (eff. 7/15/16) | www.dhhs.nh.gov Divisions/Offices; Division of Community Based Care Services - Bureau of Behavioral Health (603) 271-5007 105 Pleasant Street, Concord, NH 03301 |
DSSP 411 | DHHS Bureau of Behavioral Health (eff. 7/15/16) | www.dhhs.nh.gov Divisions/Offices; Division of Community Based Care Services - Bureau of Behavioral Health (603) 271-5007 105 Pleasant Street, Concord, NH 03301 |
DSSP 412 | Applicants for Initial Registration/Reinstatement as A Medical Technician RSA 328-I:7 (eff. 10/1/16) | www.oplc.nh.gov Office of Professional Licensure and Certification - Division of Health Professionals (603) 271-8389, 121 South Fruit Street, Concord, NH 03301 |
DSSP 413 | PL 108-79 Federal Prison Rape Elimination Act (PREA) [Contractor] (eff. 7/15/16) | www.dhhs.nh.gov Divisions/Offices; Division for Children, Youth and Families - Foster Care and Adoption (603) 271-4440 129 Pleasant Street, Concord, NH 03301 |
DSSP 414 | PL 108-79 Federal Prison Rape Elimination Act (PREA) [Staff] (eff. 7/15/16) | www.dhhs.nh.gov Divisions/Offices; Division for Children, Youth and Families - Foster Care and Adoption (603) 271-4440 129 Pleasant Street, Concord, NH 03301 |
DSSP 415 | Therapeutic Cannabis Program RSA 126-X:4, 8 (eff. 10/1/16) | www.dhhs.nh.gov Divisions/Offices; Office of Operations Support - Therapeutic Cannabis Program (603) 271-9234 129 Pleasant Street, Concord, NH 03301 |
DSSP 416 | DHHS/DCYF Transportation and Child In Home Care (eff. 7/15/16) | www.dhhs.nh.gov Divisions/Offices; Division for Children, Youth and Families - Child Development (603) 271-4242, 129 Pleasant Street, Concord, NH 03301 |
DSSP 417 | New Hampshire Medicaid Program (eff. 10/1/16) | www.dhhs.nh.gov Divisions/Offices; Office of Improvement and Integrity - Program Integrity Unit (603) 271-4344 129 Pleasant Street, Concord, NH 03301 |
DSSP 419 | NH Banking Department/Banking Division (eff. 10/1/16) | (603) 271-3561 53 Regional Drive, Suite 200, Concord, NH 03301 |
DSSP 420 | Nursing Home Administrators NH RSA 151-A:6-a (eff. 10/1/16) | www.oplc.nh.gov Office of Professional Licensure and Certification - Division of Health Professionals (603) 271-4728, 121 South Fruit Street, Suite 301, Concord, NH 03301 |
DSSP 421 | Emergency Medical and Trauma Services NH RSA 153-A:10-a (eff. 10/1/16) | Department of Safety Division of Fire Standards and Training- Bureau of Emergency Medical Services (603) 223-4200 98 Smokey Bear Blvd Concord, NH 03301 |
DSSP 422 | NH Department of Revenue Employee Candidate Background Checks RSA 21-J:3-a (eff. 10/1/16) | (603) 230-5000 109 Pleasant Street, Concord, NH 03301 |
DSSP 424 | New Hampshire Banking Department/Consumer Credit (eff. 10/1/16) | (603) 271-8675 53 Regional Drive, Suite 200, Concord, NH 03301 |
DSSP 425 | Games of Chance Facility License NH RSA 287-D:8, VII (eff. 10/1/16) | (603)271-3391 14 Integra Drive, Concord, NH 03301 |
DSSP 426 | NH Banking Department Employees RSA 383:7 (eff. 10/1/16) | (603) 271-3561 53 Regional Drive, Suite 200, Concord, NH 03301 |
DSSP 427 | Foster/Adoptive Adult Household Member Form NH RSA 170-E:29 (eff. 7/15/16) | www.dhhs.nh.gov Divisions/Offices; Division for Children, Youth and Families - Foster Care and Adoption (603) 271-4440 129 Pleasant Street, Concord, NH 03301 |
N.H. Code Admin. R. Saf-C 5703.10
(See Revision Note at chapter heading for Saf-C 5700) #6704, eff 3-3-98; amd by #8173, eff 9-21-04; amd by #8591, INTERIM, eff 3-24-06, EXPIRES: 9-20-06; ss by #8651, eff 6-2-06; ss by #9329, eff 11-21-08