AGING AND DISABILITY SERVICES ADMINISTRATION
2008 NH "Dear Administrator" Letters
March 28, 2008
ADSA: NH #2008-005
Revised Background Authorization Form
Dear Nursing Facility/Home Administrator:
In response to feedback from providers and stakeholders, the department has revised the Background Authorization form. The new form will be effective May 1, 2008. The process for submitting a Background Authorization form to BCCU remains the same. Please follow the instructions on the back of the form.
You Must:
- Begin using the new Background Authorization form # DSHS 09-653 (01/2008) by May 1, 2008. Beginning that date, the Background Check Central Unit (BCCU) will only process background checks on the new form and will reject any old forms.
You May:
- Begin using the new form immediately.
- Continue to send Background Authorization forms via FAX or U.S. mail.
- Make a photocopy of the new form (enclosed).
- Download the new form at the following Internet links:
- BCCU Intranet: http://asd.dshs.wa.gov/bccu/
- BCCU Internet: http://www1.dshs.wa.gov/msa/bccu/index.htm
- DSHS Forms Website: http://www1.dshs.wa.gov/msa/forms/eforms.html
Additionally, you may find the following information helpful:
- The requestor must provide accurate, legible information in Sections 1A and 1B. BCCU will use the information in Sections 1A and 1B to return the form, if necessary for any of the reasons listed in the Instruction Sheet. BCCU will shred any incomplete form that does not contain accurate, legible information in these two sections.
- Residential Care Services does not require that numbers 5A, 5B, 6, 17B, and 17C be filled in.
If you have questions about the status of a background check request, please continue to contact BCCU at (360) 902-0299 or bccuinquiry@dshs.wa.gov.
Sincerely,
Joyce Pashley Stockwell, Director
Residential Care Services
