Edit, Download, and Sign the Report of Suspected Child Abuse or Neglect Form DCF-136
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How do I fill this out?
To fill out this form, ensure to provide accurate and complete information. Include details about the child, suspected perpetrator, and nature of the abuse or neglect. Follow the instructions carefully to avoid any mistakes.
How to fill out the Report of Suspected Child Abuse or Neglect Form DCF-136?
1
Enter the child's name, sex, age or date of birth, and race.
2
Provide the child's address and the names of parents or guardians.
3
Describe the nature and extent of injuries, maltreatment, or neglect.
4
Include reporter's name, agency, phone number, and signature.
5
Submit the form to the relevant DCF area office listed on the form.
Who needs the Report of Suspected Child Abuse or Neglect Form DCF-136?
1
Mandated reporters such as teachers, doctors, and nurses need this form to report child abuse or neglect.
2
Social workers use this form to document cases of suspected child abuse or neglect.
3
Law enforcement agencies require this form when investigating child abuse cases.
4
Child care providers need this form to report any suspicions of child maltreatment.
5
Health care professionals use this form to document and report injuries that may indicate abuse.
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What are the instructions for submitting this form?
Submit the filled DCF-136 form within forty-eight hours of making an oral report by faxing, mailing, or delivering it to the relevant DCF area office listed on the form. Make sure to include all the necessary details accurately. For advice, double-check the form for completeness before submission and keep a copy for your records.
What are the important dates for this form in 2024 and 2025?
Submit the DCF-136 form within forty-eight hours of making an oral report. Regularly check for updates on submission deadlines.
What is the purpose of this form?
The DCF-136 form is designed to report suspected child abuse or neglect. It plays a crucial role in safeguarding the welfare of children by ensuring that all necessary details about the abuse or neglect are documented accurately. The form helps mandated reporters such as teachers, doctors, and social workers fulfill their legal obligation to report suspected cases of child maltreatment.
Tell me about this form and its components and fields line-by-line.
- 1. Child's Name: The full name of the child who is the subject of the report.
- 2. Sex: The gender of the child (M for male, F for female).
- 3. Age Or DOB: The age or date of birth of the child.
- 4. Race: The race of the child.
- 5. Child's Address: The residential address of the child.
- 6. Name Of Parents Or Other Person Responsible: Names of the child's parents or guardians.
- 7. Name Of Careline Worker: Name of the Careline worker to whom the oral report was made.
- 8. Name Of Suspected Perpetrator: Name of the suspected perpetrator, if known.
- 9. Nature And Extent Of Injury(ies): Description of the injuries, maltreatment, or neglect.
- 10. Reporter's Name: The full name of the reporter.
- 11. Agency Name: The name of the agency the reporter is affiliated with.
- 12. Phone Number: The contact number of the reporter.
- 13. Agency Address: The address of the reporter's agency.
- 14. City: The city where the reporter's agency is located.
- 15. Reporter's Signature: The signature of the reporter.
What happens if I fail to submit this form?
Failure to submit the DCF-136 form may result in legal consequences, such as fines and imprisonment.
- Legal Penalties: Non-compliance may lead to prosecution and penalties.
- Educational And Training Program: Mandatory participation in training programs.
- Class A Misdemeanor: Failure to report may result in a Class A misdemeanor charge.
- Class D Felony: Intentional interference with reporting may lead to a Class D felony.
- Fines: Monetary penalties for non-compliance.
How do I know when to use this form?
- 1. Suspected Abuse: When you have reasonable cause to suspect child abuse.
- 2. Suspected Neglect: When you believe a child is being neglected.
- 3. Mandatory Reporting: As part of your duty as a mandated reporter.
- 4. Health Professionals: When treating injuries that suggest abuse.
- 5. Child Care Providers: When observing signs of maltreatment in children.
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Can I save my progress while filling out the DCF-136 form?
Yes, ensure you save your work frequently to avoid losing any data.
Are there any penalties for not submitting the DCF-136 form?
Yes, failing to submit the form may result in legal consequences, including fines and imprisonment.
Who needs to fill out the DCF-136 form?
Mandated reporters such as teachers, doctors, social workers, and child care providers need to fill out the form.
What information is required on the DCF-136 form?
The form requires details about the child, suspected perpetrator, nature of the abuse or neglect, and reporter's information.
How do I submit the completed DCF-136 form?
Submit the form to the relevant DCF area office listed on the form, either by fax, mail, or in-person.
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