Pennsylvania Child Abuse History Clearance Form You are required to complete the form available here: www.dpw.state.pa.us/Resources/Documents/Pdf/FillInForms/DPWchildabuse.pdf Important - The original clearance reply must be turned in the first day of orientation.
- There are no exceptions.
- We will make a copy of this form for you if you do not have one for your records.
Pennsylvania Child Abuse History Clearance Instructions - You will need to print out this form. It is not possible to submit via email.
- Type or print clearly and neatly in ink Section 1 only.
- Address must be applicant’s current home address.
- All information must be completed in full. The form asks for all previous names, addresses and household members since 1975. This information must be provided to the best of your knowledge and belief. If necessary, attach additional pages.
- The application must be signed.
- A money order for $10 made out to “Department of Public Welfare” must accompany the form or it will not be processed. You will be reimbursed with the submission of your moving expenses. Mail to:
Childline and Abuse Registry
Department of Public Welfare
PO Box 8170
Harrisburg, PA 17105-8170 - Do not send any postage paid return envelopes.
- Application should be placed in a business-sized or larger envelope prior to mailing.
- The Child Care block must be checked for Purpose for Clearance. Do not check more than one block.
Clearance results will be returned via mail to the home address listed on the form within 14 days from the date that the clearance is received by the state office. There will be no replacement certificates issued after 90 days. Failure to comply with the above instructions will cause considerable delay. If you have questions, call the Childline and Abuse Registry: (717) 783-6211. | 
