Out of State Registry Check (If you work for a child care in TN)

The overall background check process includes a check of any applicable out of state registries if the applicant has lived in another state during the last (5) years. Please see the instructions for completing the out of state registry check portion of the background check process below.

If an applicant for child care employment has lived in another state during the last five (5) years select the state(s) from the tabs at the top of the box with the corresponding first letter of the state for which you are searching and follow the instructions for each state in which the individual has lived. Submit the forms as instructed along with any required documentation. Each form may have different requirements. Most forms require a signature. Others may require a witness, original signatures, notarization, and some require a copy of the applicant's photo identification. 

After the applicant has completed all applicable out of state forms, they are to send them - along with their completed Child Care Fingerprint Sample Registration/Criminal/Juvenile History & State Registry Review Disclosure form - to the Nashville Department of Human Services office. Note that California requires the applicant to send their completed California form directly to California. In this case, the applicant is also required to submit to the Nashville Department of Human Services office a copy of the California-addressed envelope in which the applicant mailed the California form to California as proof that the applicant mailed this form to California. Unless directions specify an original form is required, each applicant’s forms should be submitted to our office, together, by email: ccbackground.dhs@tn.gov or fax: 615-532-9956. Applicant’s having state forms that are required to be original should mail all of their paperwork to:

Tennessee Department of Human Services
Attn: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243

The state of Tennessee covers all fees for Tennessee Department of Human Services fingerprinting and all out of state background checks that require a fee.

Commonly Used Acronyms

CAN = Child Abuse and Neglect Registry
N/A = Not Applicable
TBD = To Be Determined
VPR = Vulnerable Persons Registry (or equivalent)

Instructions:

Each state is categorized in alphabetical order in the box below. Please select a state(s) from the tabs at the top of the box with the corresponding first letter of the state(s) for which you are searching. Please be sure to read all information regarding your selected state as information can vary between states. Some states may return forms unprocessed if information is missing or unreadable. In addition to any required forms for other states, each applicant must submit a Child Care Criminal/Juvenile History & State Registry Review Disclosure Form. 

Return any required forms to DHS via the options listed below:

Important Note: ONLY SEND FORMS WITH PERSONALLY IDENTIFIABLE INFORMATION USING A SECURE METHOD.

  • FAX: 615-532-9956 This is a dedicated fax that goes directly to the registry check processing unit.
  • MAILING ADDRESS: Tennessee Department of Human Services, ATTN: OIG - Background Unit, James K. Polk Building, 15th Floor 505 Deaderick Street Nashville, TN 37243
  • EMAIL: Use the mailbox below for general communications about the background check process. DO NOT USE THE MAILBOX TO SEND PERSONALLY IDENTIFIABLE INFORMATION UNLESS YOU HAVE THE ABILITY TO SEND SECURE EMAIL. CCBackground.DHS@tn.gov


Additional Information:

As the volume of registry check requests to other states increases, other states may change their process/forms to better accommodate those requests. Therefore, we will update this information as needed to reflect any changes in the process. If you require additional information about the background check process, you can contact us via the dedicated phone line at: (615) 253-4170.

Alabama

Checklist: Alabama Checklist

Form: for CAN and Criminal

Please note the following when completing the Alabama form:

  • Alabama requires the original form (not a copy, but originally written on in ink).
  • Please make sure to include full name; ex. last name, first name, full middle name, no initials accepted
  • Please make sure to include applicant’s job/role
  • Please make sure to include date of birth for all spouse, former spouse, children and stepchildren listed
  • Please make sure to include all Alabama counties where applicant lived, worked or attended school
  • Alabama requires a witness signature
  • Applicant and witness signature dates must match

Please do NOT send this form to Alabama. Please send the original form to TN DHS, and TN DHS will send it to Alabama.

Instructions

Mail a copy of the checklist, disclosure form and original Alabama form to:
Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243

Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms for each applicant, together, including the checklist.

______________________________________________________________________________________________________________

Alaska

Checklist: Alaska Checklist

Forms: For CAN and Criminal

Please do NOT send this form to Alaska. Please send it to TN DHS, and TN DHS will send it to Alaska.

 

Instructions

Email, fax or mail checklist, disclosure form and Alaska form to: 
Email: ccbackground.dhs@tn.gov 
Fax: 615-532-9956
Mail:

Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243

Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.

______________________________________________________________________________________________________________

American Samoa

American Samoa

Checklist: American Samoa Checklist

Forms: For CAN and Criminal

Please do NOT send this form to American Samoa. Please send it to TN DHS, and TN DHS will send it to American Samoa.

Instructions

Email, fax, or mail checklist, disclosure form to:
Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956
Mail:

Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243

Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.

______________________________________________________________________________________________________________

Arizona

Checklist: Arizona Checklist

Forms: For CAN and Criminal

Please do NOT send this form to Arizona. Please send it to TN DHS, and TN DHS will send it to Arizona.

Instructions

Email, fax or mail checklist, disclosure form and Arizona form to:
Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956
Mail:

Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243

Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms for each applicant together, including the checklist.

______________________________________________________________________________________________________________

Arkansas

Checklist: Arkansas Checklist

Forms: For CAN and Criminal

Please note the following when completing the Arkansas form:

  • Have both Arkansas forms notarized

Please do NOT send these forms to Arkansas. Please send them to TN DHS, and TN DHS will send it to Arkansas.

Instructions

Email, fax or mail the checklist, disclosure form and both Arkansas forms to:
Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956
Mail:

Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243

Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms for each applicant together, including the checklist.

______________________________________________________________________________________________________________

California

Checklist: California Checklist

Form: for CAN and Criminal

Please note the following when completing the California form:

  • Have California form notarized
  • Make two copies of notarized California Child Abuse Central Index Self Inquiry Request form
  • Keep original notarized California Child Abuse Central Index Self Inquiry Request form on file
  • Applicant mails one copy of the notarized California Child Abuse Central Index Self Inquiry Request form directly to California with their return address on the envelope

Please Note: Do not send the TN Disclosure form – only send the California Abuse Central Index Self Inquiry Request form. Otherwise, California will reject the request.

Instructions

Email, fax or mail the checklist, disclosure form, copy of notarized California Child Abuse Central Index Self Inquiry Request form and copy of envelope the California form was mailed to California in to:
Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956
Mail:

Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243

Please Note: Email, fax or mail a copy of the California results to our office, as soon as possible, after they have been received.

Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms for each applicant together, including the checklist.

______________________________________________________________________________________________________________

Colorado

Checklist: Colorado Checklist

Form: for CAN and Criminal

  • Colorado requires that the form be typed
  • Complete disclosure form: https://www.tn.gov/content/dam/tn/human-services/documents/New%20TN%20Disclosure%20Form%20(rev.%2010-2022).pdf
  • At the bottom of page 2 in Section B, on the Colorado form, the current and former spouse’s information should be either listed or it should be left blank if the applicant has never had a spouse.
  • Signature on the Colorado form must be hand-signed, it cannot be electronic
  • A clear copy of the applicant’s driver’s license is required.
  • Applicant will receive the Colorado results. Once received, please email or fax a copy of the Colorado results to our Nashville DHS office email: ccbackground.dhs@tn.gov or fax: 615-532-9956.

Please do NOT send this form to Colorado. Please send it to TN DHS, and TN DHS will send it to Colorado.

Instructions

Email, fax or mail checklist, disclosure form and typed Colorado form to:
Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956
Mail:

Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243

Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.

______________________________________________________________________________________________________________

Connecticut  

Checklist: Connecticut Checklist

Forms: For CAN and Criminal

Please do NOT send this form to Connecticut. Please send it to TN DHS, and TN DHS will send it to Connecticut.

Instructions

Email, fax, or mail checklist, disclosure form and Connecticut form to:
Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956
Mail:

Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243

Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.

______________________________________________________________________________________________________________

Delaware

Checklist: Delaware Checklist

Forms: For CAN and Criminal

Please do NOT send this form to Delaware. Please send it to TN DHS, and TN DHS will send it to Delaware.

Instructions

Email, fax or mail checklist, disclosure form and Delaware form to:
Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956
Mail:

Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243

Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.

Florida

Checklist: Florida Checklist

Form: for CAN and Criminal 

Please do NOT send this form to Florida. Please send it to TN DHS, and TN DHS will send it to Florida.

 

Please do NOT sign as the requestor. TN DHS signs as the requestor.

Instructions

Email, fax or mail checklist, disclosure form and Florida form to:
Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956
Mail:

Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243

Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.

______________________________________________________________________________________________________________

Georgia

Checklist: Georgia Checklist 

Forms: For CAN and Criminal

Instructions

Email, fax, or mail checklist, disclosure form to:
Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956
Mail:

Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243

Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.

______________________________________________________________________________________________________________

Guam

Checklist: Guam Checklist

Forms: For CAN and Criminal

Please do NOT send this form to Guam. Please send it to TN DHS, and TN DHS will send it to Guam.

Instructions

Email, fax or mail checklist, Guam form and disclosure form to:
Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956
Mail:

Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243

Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.

______________________________________________________________________________________________________________

Hawaii

Checklist: Hawaii Checklist

Forms: For CAN and Criminal

Please note: Hawaii requires the original form

Please do NOT send this form to Hawaii. Please send it to TN DHS, and TN DHS will send it to Hawaii.

Instructions

Mail a copy of the checklist, disclosure form and original Hawaii form to:
Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243

Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.

Idaho

Checklist: Idaho Checklist

Form: for CAN and Criminal

Please note the following when completing the Idaho form:

  • Have Idaho form notarized

Please do NOT send this form to Idaho. Please send the original form to TN DHS, and TN DHS will send it to Idaho.

Instructions

Email, fax or mail checklist, disclosure form and Idaho form to:
Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956
Mail:

Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243

Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.

______________________________________________________________________________________________________________

Illinois

Checklist: Illinois Checklist

Form: for CAN and Criminal

Please do NOT send the IL form to Illinois and please do NOT send the IL Criminal Release form to CastleBranch. Please send these forms to TN DHS, and TN DHS will send them to Illinois and to CastleBranch.

Instructions

Email, fax or mail checklist, disclosure form and Illinois forms to:
Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956
Mail:

Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243

Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.

______________________________________________________________________________________________________________

Indiana

Checklist: Indiana Checklist

Forms: for CAN and Criminal

Instructions

Email, fax or mail checklist and disclosure form to:
Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956
Mail:

Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243

Please Note: Applicant completes online Indiana form, sent to applicant’s email, after disclosure form has been received in our office

Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.

______________________________________________________________________________________________________________

Iowa

Checklist: Iowa Checklist

Forms: for CAN and Criminal

Please do NOT sign on Requestor’s signature line. TN DHS signs on that line.

Please do NOT send this form to Iowa. Please send the form to TN DHS, and TN DHS will send it to Iowa.

Instructions

Email, fax or mail checklist, disclosure form and Iowa form to:
Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956
Mail:

Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243

Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.

______________________________________________________________________________________________________________

Kansas

Checklist: Kansas Checklist

Form: for CAN and Criminal

Please do NOT send these forms to Kansas. Please send the forms to TN DHS, and TN DHS will send them to Kansas.

Instructions

Email, fax or mail the checklist, disclosure form and both Kansas forms to:
Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956
Mail:

Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243

Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.

______________________________________________________________________________________________________________

Kentucky

Checklist: Kentucky Checklist

Form: for CAN and Criminal

Please note the following when completing the Kentucky form:

  • Please make sure to include full name; ex. first name, middle name, nick name, maiden name, last name
  • Kentucky requires a witness signature
  • Applicant and witness signature dates must match
  • A clear copy of the applicant’s driver’s license is required

Please do NOT send this form or payment to Kentucky. Please send the form to TN DHS, and TN DHS will send it to Kentucky with payment.

Instructions

Email, fax, or mail the checklist, disclosure form, clear copy of driver’s license and Kentucky form to:
Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956
Mail:

Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243

Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.

______________________________________________________________________________________________________________

Louisiana

Checklist: Louisiana Checklist

Form: for CAN and Criminal

Please note the following when completing the Louisiana form:

  • A clear copy of the applicant's driver's license is required

Please do NOT sign on the Requestor’s signature line. TN DHS will sign on that line.

Please do NOT send this form to Louisiana. Please send the form to TN DHS, and TN DHS will send it to Louisiana.

Instructions

Email, fax or mail checklist, disclosure form, clear copy of driver's license and Louisiana form to:
Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956
Mail:

Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243

Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.

______________________________________________________________________________________________________________

Maine

Checklist: Maine Checklist

Form: for CAN and Criminal

Please do NOT send this form to Maine. Please send the form to TN DHS, and TN DHS will send it to Maine.

Instructions

Mail a copy of the checklist, disclosure form and original Maine form to:
Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243

Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.

______________________________________________________________________________________________________________

Maryland

Checklist: Maryland Checklist

Forms: for CAN and Criminal

Please note the following when completing the Maryland form:

  • Maryland requires that the form be typed
  • Maryland requires the form to be notarized
  • Maryland requires the original form

Please do NOT send this form to Maryland. Please send the original form to TN DHS, and TN DHS will send it to Maryland.

Instructions

Mail a copy of the checklist, disclosure form and original Maryland form to:
Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243

Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.

______________________________________________________________________________________________________________

Massachusetts

Checklist: Massachusetts Checklist

Form: for CAN and Criminal

Please do NOT send this form to Massachusetts. Please send the form to TN DHS, and TN DHS will send it to Massachusetts.

Instructions

Email, fax or mail checklist, Massachusetts form and disclosure form to:
Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956
Mail:

Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243

Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.

______________________________________________________________________________________________________________

Michigan

Checklist: Michigan Checklist

Form: for CAN and Criminal

Please note: Michigan requires a clear copy of the applicant’s driver’s license

Please do NOT send this form to Michigan. Please send the form to TN DHS, and TN DHS will send it to Michigan.

Instructions

Email, fax, or mail the checklist, disclosure form, clear copy of driver’s license and Michigan form to:
Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956
Mail:

Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243

Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.

______________________________________________________________________________________________________________

Minnesota

Checklist: Minnesota Checklist

Form: for CAN and Criminal

Please Note: Have Minnesota form notarized

Please do NOT send this form to Minnesota with payment. Please send the form to TN DHS, and TN DHS will send it to Minnesota with payment.

Instructions

Email, fax or mail checklist, disclosure form and Minnesota form to:
Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956
Mail:

Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243

Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.

______________________________________________________________________________________________________________

Mississippi

Checklist: Mississippi Checklist

Form: for CAN and Criminal

Mississippi Department of Health
Criminal History Record Check Unit
Attn: Julie Henderson
143B LeFleurs Square
Jackson, MS. 39211

  • Also, please email or fax a copy of the applicant’s ink fingerprint card, a clear copy of the applicant’s driver’s license, Mississippi checklist and completed disclosure form to:

Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956

  • When the disclosure form, driver’s license, and copy of the ink fingerprint card are received in the Nashville DHS office, an online Mississippi DocuSign form will be emailed to the applicant’s email address listed on their disclosure form. Please have the applicant watch for this Mississippi DocuSign form in their inbox and junk/spam folders.
  • Applicant completes and submits the online Mississippi Child Abuse Registry Check DocuSign Form.

*Mailing the hardcopy ink fingerprint card (cannot be bent) via USPS Priority Mail, FedEx, or UPS with a tracking number is recommended.

*TN DHS does not cover the payment for the hardcopy ink fingerprint to be completed or the mail delivery services*

*Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. Please also send all forms for each applicant together, including the checklist.

*Mailing these documents via USPS Priority Mail, FedEx, or UPS with a tracking number is recommended.

______________________________________________________________________________________________________________

Missouri

Checklist: Missouri Checklist

Form: for CAN and Criminal

  • Applicant Completes disclosure form: https://www.tn.gov/content/dam/tn/human-services/documents/New%20TN%20Disclosure%20Form%20(rev.%2010-2022).pdf
  • Provider completes Employer Background Screening Request form: https://www.tn.gov/content/dam/tn/human-services/documents/Employer%20Background%20Screening%20Request%20Form.pdf
    • For section “Employer associated with this registration”: please list this information as Provider’s (you) Child Care Agency information.
  • Provider must call Missouri to verify if the applicant is registered in their system. If the applicant is not registered, the provider must register them. If the applicant is already registered, the provider must request the background check over the phone. Toll Free Number: (866) 422-6872; OR General Office Telephone: (573) 526-1974.
    • To register online with a credit/debit card, go to: www.health.mo.gov/safety/fcsr
    • To register via mail with a hard copy check/money order, etc., applicant must complete the Worker Registration Form: https://www.tn.gov/content/dam/tn/human-services/documents/Missouri.pdf and mail the form, applicant’s Social Security Card, and payment to:
      • Missouri Department of Health and Senior Services
        Attn: Fee Receipts
        PO BOX 570
        Jefferson, MO 65102
    •  Please note that there is a one-time $14 registration fee that must be paid by the provider each time an applicant needs to be registered in the system (per Missouri’s law pertaining to this background check request, TN DHS is not authorized to cover this fee).
  • Please Email, fax or mail a copy of the checklist, disclosure form and Missouri Screening results to our Nashville DHS office (if results have not been received by the time the Out of State documents are submitted to Nashville DHS, please provide proof of the applicant’s screening having been requested from Missouri):

Instructions

Email, fax or mail checklist, disclosure form and Missouri form to:
Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956
Mail:

Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243

Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist

______________________________________________________________________________________________________________

Montana

Checklist: Montana Checklist

Please note the following when completing the Montana form:

  • Have Montana form notarized

Please do NOT send this form to Montana. Please send the form to TN DHS, and TN DHS will send it to Montana.

Instructions

Email, fax or mail checklist, disclosure form and Montana form to:
Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956
Mail:

Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243

Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.

Nebraska

Checklist: Nebraska Checklist

Form: for CAN and Criminal

Instructions

Email, fax or mail checklist and disclosure form to:
Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956
Mail:

Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243

Please Note: Applicant completes online Nebraska form, sent to applicant’s email, after disclosure form has been received in our office

Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.

______________________________________________________________________________________________________________

Nevada

Checklist: Nevada Checklist

Form: for CAN and Criminal

Please do NOT send this form to Nevada. Please send it to TN DHS, and TN DHS will send it to Nevada.

Please note: Nevada requires their form to be notarized

Instructions

Email, fax, or mail the checklist, disclosure form and notarized Nevada form to:
Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956
Mail:

Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243

Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.

______________________________________________________________________________________________________________

New Hampshire

Checklist: New Hampshire Checklist

Form: for CAN and Criminal

Please do NOT send these forms to New Hampshire or to CastleBranch. Please send them to TN DHS, and TN DHS will send to New Hampshire and CastleBranch.

 

Instructions

Email, fax or mail checklist, disclosure form and notarized New Hampshire forms to:
Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956
Mail:

Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243

Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.

______________________________________________________________________________________________________________

New Jersey

Checklist: New Jersey Checklist

Form: for CAN and Criminal

Here is a link: https://www.njportal.com/dcf/cari

  • Click on “File an Out of State CARI” in the lower left box.
  • Then enter the following information for “Requesting Agency Name and Information”:
    • Requesting Agency Name: TN Department of Human Services
    • Staff Name: Basem Girgis
    • Agency Email:  CCBackground.DHS@tn.gov
    • Contact Phone Number: 615-253-4170
    • Address 1: James K. Polk Building, 15th Floor
    • Address 2: 505 Deaderick Street
    • City: Nashville
    • State: Tennessee
    • Zip: 37243

Please do NOT enter the center’s information as the requestor’s information. Please enter the information listed above for TN DHS.

Instructions

Email, fax or mail checklist and disclosure form to:
Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956
Mail:

Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243

Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.

______________________________________________________________________________________________________________

New Mexico

Checklist: New Mexico Checklist

Form: for CAN and Criminal

Please do NOT send this form to New Mexico. Please send it TN DHS, and TN DHS will send it to New Mexico.

Instructions

Email, fax or mail checklist, disclosure form and New Mexico form to:
Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956
Mail:

Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243

Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.

______________________________________________________________________________________________________________

New York

Checklist: New York Checklist

Form: for CAN and Criminal

Please note the following when completing the New York form:

  • New York requires the form to be notarized
  • New York requires the original form

Please do NOT send the original form to New York. Please send it to TN DHS, and TN DHS will send it to New York.

Instructions

Mail a copy of the checklist, disclosure form and original New York form to:
Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243

Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.

______________________________________________________________________________________________________________

North Carolina

Checklist: North Carolina Checklist

Form: for CAN and Criminal

  • Please note: only the applicant is authorized to create a login and request this check.
  • Please note: when requesting the background check, under “provider search,” the applicant must use code “InterstateApp” to let the system know they are requesting an Out of State check.
  •  Please note: the applicant must provide their previous NC address history.
  • Please note: this form does NOT require a fee. If the applicant is prompted to pay a fee, please stop and contact NC. Let them know the applicant is requesting an “interstate” check for TN employment, and they will assist.
  • Please note: the applicant will receive their results from NC – these must be forwarded to TN DHS as soon as they are received by the applicant.

Instructions

Email, fax or mail checklist, disclosure form and request confirmation of online North Carolina form to:
Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956
Mail:

Tennessee Department of Human Services
ATTN: Basem Girgis / OIG Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243

Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. Please also send all forms for each applicant together, including the checklist.

______________________________________________________________________________________________________________

North Dakota

Checklist: North Dakota Checklist

Form: for CAN and Criminal

Please do NOT send this form to North Dakota. Please send it to TN DHS, and TN DHS will send it to North Dakota.

Instructions

Email, fax or mail checklist, disclosure form and North Dakota form to:
Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956
Mail:

Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243

Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.

______________________________________________________________________________________________________________

Northern Mariana Islands

Checklist: Northern Mariana Islands Checklist

Form: for CAN and Criminal

Instructions

Email, fax, or mail checklist, disclosure form to:
Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956
Mail:

Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243

Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.

______________________________________________________________________________________________________________

Ohio

Checklist: Ohio Checklist

Form: for CAN and Criminal

Please do NOT send this form to Ohio. Please send it to TN DHS, and TN DHS will send it to Ohio.

Instructions

Email, fax or mail checklist, disclosure form and Ohio form to:
Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956
Mail:

Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243

Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.

______________________________________________________________________________________________________________

Oklahoma

Checklist: Oklahoma Checklist

Form: for CAN and Criminal

·       Applicant’s previous Oklahoma address needs to be listed on the Oklahoma form.

Please do NOT send this form Oklahoma. Please send it to TN DHS, and TN DHS will send it to Oklahoma.

 

Instructions

Email, fax or mail checklist, disclosure form and Oklahoma form to:
Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956
Mail:

Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243

Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.

______________________________________________________________________________________________________________

Oregon

Checklist: Oregon Checklist

Form: for CAN and Criminal

Please note the following when completing the Oregon form:

  • Oregon requires that the form be typed

Please do NOT send this form to Oregon. Please send it to TN DHS, and TN DHS will send it to Oregon.

Instructions

Email, fax or mail a copy of the checklist, disclosure form and Oregon form to:
Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956
Mail:

Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243

Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.

______________________________________________________________________________________________________________

Pennsylvania

Checklist: Pennsylvania Checklist

Form: for CAN and Criminal

Please do NOT send these forms to Pennsylvania. Please send them to TN DHS, and TN DHS will send them to Pennsylvania.

Instructions

Email, fax or mail checklist, disclosure form and Pennsylvania forms to:
Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956
Mail:

Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243

Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.

______________________________________________________________________________________________________________

Puerto Rico

Checklist: Puerto Rico Checklist

Form: for CAN and Criminal

Please note the following when completing the Puerto Rico form:

·         Puerto Rico requires the form to be witnessed (applicant and witness signatures dates must match)

Please do NOT send this form to Puerto Rico. Please send it to TN DHS, and TN DHS will send it to Puerto Rico.

Instructions

Email, fax or mail a copy of the checklist, disclosure form and Puerto Rico form to:
Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956
Mail:

Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243

Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.

Rhode Island

Checklist: Rhode Island Checklist

Form: for CAN and Criminal

Email, fax or mail checklist, disclosure form, and Rhode Island form to:

Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956

Mail:
Tennessee Department of Human Services
ATTN: Basem Girgis / OIG Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243

*Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. Please also send all forms for each applicant together, including the checklist.

______________________________________________________________________________________________________________

South Carolina

Checklist: South Carolina Checklist

Please do NOT send this form to South Carolina. Please send it to TN DHS, and TN DHS will send it to South Carolina.

Instructions

Email, fax or mail a copy of the checklist, disclosure form and South Carolina form to:
Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956
Mail:

Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243

Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.

______________________________________________________________________________________________________________

South Dakota

Checklist: South Dakota Checklist

Please do NOT send this form to South Dakota. Please send it to TN DHS, and TN DHS will send it to South Dakota.

Please note the following when completing the South Dakota form:

  • South Dakota requires the form to be notarized

Instructions

Email, fax or mail a copy of the checklist, disclosure form and South Dakota form to:
Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956
Mail:

Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243

Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.

______________________________________________________________________________________________________________

Texas

Checklist: Texas Checklist

Form: for CAN and Criminal

Please do NOT send this form to Texas. Please send it to TN DHS, and TN DHS will send it to Texas.

Please note the following when completing the Texas form:

  • Texas requires the form to be notarized

Instructions

Email, fax or mail a copy of the checklist, disclosure form and Texas form to:
Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956
Mail:

Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243

Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.

Utah

Checklist: Utah Checklist

Form: for CAN and Criminal 

Please do NOT send this form and driver’s license to Utah. Please send it to TN DHS, and TN DHS will send it to Utah.

Please Note: Utah requires a clear copy of the applicant’s driver’s license

Instructions

Email, fax, or mail the checklist, disclosure form, clear copy of driver’s license and Utah form to:
Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956
Mail:

Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243

Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.

______________________________________________________________________________________________________________

Vermont

Checklist: Vermont Checklist

Form: for CAN and Criminal 

Please note the following when completing the Vermont form:

  • Vermont requires the form to be notarized
  • Vermont requires the original form

Please do NOT send this form to Vermont. Please send the original form to TN DHS, and TN DHS will send it to Vermont.

Instructions

Mail a copy of the checklist, disclosure form and original Vermont form to:
Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243

Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.

______________________________________________________________________________________________________________

Virgin Islands

Checklist: Virgin Islands Checklist

Form: for CAN and Criminal 

Please note the following when completing the Virgin Islands form:

  • The Virgin Islands require the form to be witnessed

Please do NOT send this form to the Virgin Islands. Please send it to TN DHS, and TN DHS will send it to the Virgin Islands.

Instructions

Email, fax or mail a copy of the checklist, disclosure form and Virgin Islands form to:
Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956
Mail:

Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street

Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.

______________________________________________________________________________________________________________

Virginia 

Checklist: Virginia Checklist

Form: for CAN and Criminal 

Complete disclosure form: https://www.tn.gov/content/dam/tn/human-services/documents/New%20TN%20Disclosure%20Form%20(rev.%2010-2022).pdf

Complete the Virginia form: https://www.tn.gov/content/dam/tn/human-services/documents/Virginia_1.pdf

Please note the following when completing the Virginia form:

  • Virginia requires the form to be notarized
  • Virginia requires the original form

Please do NOT send this form to Virginia. Please send the original form to TN DHS, and TN DHS will send it to Virginia.

Instructions

Mail a copy of the checklist, disclosure form and original Virginia form to:
Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243

Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.

______________________________________________________________________________________________________________

Washington

Checklist: Washington Checklist

Form: for CAN and Criminal 

Please Note: Washington requires that the form be typed and have a handwritten signature – cannot be electronic signature.

Please do NOT send this form to Washington. Please send it to TN DHS, and TN DHS will send it to Washington.

Instructions

Email, fax or mail a copy of the checklist, disclosure form and Washington form to:
Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956
Mail:

Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243

Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.

______________________________________________________________________________________________________________

Washington D.C.

Checklist: Washington D.C. Checklist

Form: for CAN and Criminal 

Please note the following when completing the Washington D.C. form:

  • Washington DC requires a copy of the applicant’s driver’s license

Please do NOT send this form to Washington D.C. Please send the form to TN DHS, and TN DHS will send it to Washington D.C.

Instructions

Mail a copy of the checklist, disclosure form and original Washington D.C. form to:
Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243

Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956

Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.

______________________________________________________________________________________________________________

West Virginia

Checklist: West Virginia Checklist

Form: for CAN and Criminal

Please Note: West Virginia requires the original form

Please do NOT send this form to West Virginia. Please send the original form to TN DHS, and TN DHS will send it to West Virginia.

Instruction

Mail a copy of the checklist, disclosure form and original West Virginia form to:
Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243

Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.

______________________________________________________________________________________________________________

Wisconsin

Checklist: Wisconsin Checklist

Form: for CAN and Criminal 

Please note the following when completing the Wisconsin form:

  • Wisconsin requires the form to be witnessed

Please do NOT send this form to Wisconsin. Please send it to TN DHS, and TN DHS will send it to Wisconsin.

Instructions

Email, fax or mail a copy of the checklist, disclosure form and Wisconsin form to:
Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956
Mail:

Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243

Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.

______________________________________________________________________________________________________________

Wyoming

Checklist: Wyoming Checklist

Form: for CAN and Criminal 

Please do NOT send this form to Wyoming. Please send the original form to TN DHS, and TN DHS will send it to Wyoming.

Instructions

Mail a copy of the checklist, disclosure form and original Wyoming form to:
Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243

Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.