Read State of Illinois text version

CANTS 48 Rev. 08/2009

State of Illinois Department of Children and Social Services REQUEST FOR LEADS / CANTS CHECK

To:

State Central Register / LEADS Operator FAX: (217) 524-0359 Office: (217) 785-3202 Worker Name Agency Office Phone Worker ID POS / DCFS Region/Site/Field Office Fax

From:

I have signed a CFS 853, Acknowledgment of Limits of LEADS Access and Confidentiality of LEADS Information Note: Worker may only continue if this box is checked. Purpose of Leads / Cants Check 1. 2. Note: Worker must provide applicable information.

Child Protection Investigation: Provide SCR # Child Welfare Services Referral: Provider SACWIS Intake # Extended Family Support Program Dependency and check reason below:

Completed CFS 1440B Client Contact and check reason below: ACR Frequent Visitor Adoption

3.

Child Welfare Services: Provide Case ID # a. b. Unlicensed Relative Foster Home: Family Composition Changes For DCFS Wards: Return Home Subsidized Guardianship Integrated Assessment Unauthorized Self-Select Visitation Court Ordered

Home Study

Protective Service Plan Transitional Living Program

Intact Family

Closing Intact Case Job Corp

Pre-Placement Check

NOTE: LEAD CHECKS ARE NOT TO BE CONDUCTED ON LICENSED PROVIDERS. CANTS / LEADS INFORMATION ­ Worker to Complete Last Name First Name MI Sex Race Date of Birth Social Security No. SCR Use Only *P/N

* P = Positive / Possible Criminal History Identified N = Negative / No Criminal History Identified Positive LEADS information will be mailed to worker within 24 hours SCR # Date RTO CANTS INFORMATION ­ SCR Use Only Status Allegation Perpetrator Victim Case Name

Check box below: LEADS Confirmation # LEADS / CANTS Check completed by: For call-ins only: SCR has asked if worker signed CFS 853 Faxed by: Mailed by:

Information

State of Illinois

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