Your request may be denied in certain limited circumstances.Send the completed form to: Privacy Office, MDHHS 333 South Grand Avenue Lansing, MI 48933 Fax: 517-241-1200 Email: HYPERLINK "mailto:MDHHS-Subpoena@michigan.gov" MDHHS-Subpoena@michigan.govYou have the right to file a privacy complaint:Individuals can file privacy complaints with either MDHHS or the U.S. Department of Health and Human Services, Office of Civil Rights. FORMCHECKBOX Email FORMCHECKBOX Fax FORMCHECKBOX U.S. MailSend records to (specify individual if different from individual whose records are being requested) FORMTEXT S t r e e t a d d r e s s F O R M T E X T C i t y S t a t e Z I P c o d e F O R M T E X T F O R M T E X T F O R M T E X T E m a i l F a x n u m b e r F O R M T E X T F O R M T E X T L e g a l r e p r e s e n t a t i v e s n a m e L e g a l r e p r e s e n t a t i v e s r e l a t i o n s h i p t o i n d i v i d u a l ( A l e t t e r o f a u t h o r i t y m a y b e r e q u e s t e d ) F O R M T E X T F O R M T E X T S i g n a t u r e o f I n d i v i d u a l o r l e g a l r e p r e s e n t a t i v e D a t e F O R M T E X T Y o u h a v e t h e f o l l o w i n g r i g h t s t o a c c e s s y o u r i n f o r m a t i o n : Y o u h a v e a r i g h t t o h a v e a n a n s wer to your request within 30 calendar days. Please provide as much information as possible, including full names and dates of birth for the child, the parents and the alleged perpetrator (if a caregiver other than a parent). The Michigan Department of Health and Human Services (MDHHS) keeps this list. The following is a list of information that may be redacted. Contact the CPS Emergency Contact Number 1-855-444-3911 to make a report of suspected child abuse and or neglect: Department of Human Services. Grand Rapids, MI 49546 OR Fax this form to 616-977-1154 or 616-977-1158 Or email this form to DHS-CPS-CIGroup@michigan.gov Date - Enter the date the form is being completed. Our office hours are 8 a.m. through 5 p.m. Monday through Friday. Box 8053 Harrisburg, PA 17105 If you disagree with the MDHHS decision to list your name on the Central Registry, write a letter to the MDHHS director in the county where the investigation occurred. Michigan's Women, Infants & Children program, providing supplemental nutrition, breastfeeding information, and other resources for healthy mothers & babies. 0 Children's Protective Services Investigation Process Investigation CPS has 30 days to complete an investigation unless extenuating circumstances require an extension. Former or current students seeking their elementary and high school transcripts for a DACA filing should submit a printable application with a $3.00 money order made payable to Chicago Public Schools or via e-pay below, and indicate that the request is for purposes of a DACA filing. 60632. Access to Records Request - MI Health Most states have laws authorizing a statewide central registry, which is a centralized listing of child maltreatment records. 8-13) Previous edition obsolete. Information & resources for Community and Faith-Based partners. You may have to ask MDHHS in writing to remove your name at the end of ten years. MDHHS News, Press Releases, Media toolkit, and Media Inquiries. P l e a s e n o t e t h a t n o t a l l r e c o r d s a r e a v a i l a b le electronically. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); In Michigan, if you have been charged with child abuse or child neglect (Category I or II), you will be placed on Michigans Central Registry. A response letter will be sent within ten business days to the individual or authorizedrequester seeking a central registry clearance on an individual. CPS and Your Family | Michigan Legal Help List child(ren) suspected of being abused or neglected - Enter available information for the child(ren) believed to be abused or neglected. Please turn on JavaScript and try again. Please update to a modern browser such as Chrome, Firefox or Edge to experience all features Michigan.gov has to offer. Current CPS students should see their school counselor to request a copy of their transcript. Michigan Department of Health and Human Services (MDHHS), The names and birthdates of people who abused or neglected a child, The names and birthdates of children who were abused or neglected, The names of other adults or children who were in a home with an abused or neglected child but were not involved in the abuse or neglect, The type of abuse or neglect that happened, You have the right to review the case record, Who can view your name on the Central Registry, What to do if you disagree with your name being listed on the Central Registry. Please be advised that incomplete or inaccurate information may delay the processing of your request. Bridge Card Participation Information on Electronic Benefits for clients and businesses, lists of participating retailers and ATMs, and QUEST. Michigan Legislature - Section 722.628 PDF LAW ENFORCEMENT INFORMATION NETWORK (LEIN) - Michigan Department of (1) Within 24 hours after receiving a report made under this act, the department must refer the report to the prosecuting attorney and the local law enforcement agency if the report meets the requirements of subsection (3) (a), (b), or (c) or section 3 (6) or (9) or must commence an investigation of the child suspected of being abused or neglected. S Note: An administrative hearing may be scheduled if it is determined that your requestfor hearing was made within 60 days after the 180-day period expired and there is good causefor delay. Getting Access to CPS Records. Even though the DHHS / CPS Central Registry is internal to the government, it is understandable that people do not want to be listed on the Central Registry. Information on How to Bid, Requests for Proposals, forms and publications, contractor rates, and manuals. 133 0 obj <>/Filter/FlateDecode/ID[<039D8C3E4DE15C459EE787FA463E5B7D>]/Index[85 303]/Info 84 0 R/Length 209/Prev 367567/Root 86 0 R/Size 388/Type/XRef/W[1 3 1]>>stream You may be asked to contact your direct care provider to access psychotherapy notes or other treatment information if your direct care provider created the original record.