BCAL-1326A (Rev. 11-13) Previous edition obsolete. MS Word 1
LICENSING RECORD CLEARANCE REQUEST
Verify the address of a family home applicant with Secretary of State records.
Produce a Bureau of Children and Adult Licensing (BCAL) files check for a cur
rent or previous licensee status of the
applicant in any county of the state.
Produce a Department of State Police check regarding the possible existence of a conviction record.
Instructions for processing:
The Licensing Record Clearance (BCAL-1326A) must be taken with you at the time the FBI
fingerprint is conducted. Note: The TCN# will be filled in by the Fingerprint Specialist and must be completed prior to
submitting the form.
Fingerprint check of Adult Foster Care and Home for the Aged license applicants and others as required by licensing statues.
You may select a fingerprint vendor at www.michigan.gov/msp/0,1607,7-123-1589_1878_8311-237662--,00.html
The existence of a conviction record does not necessarily disqualify an applicant for licensure, or an individual from
employment or residents in an adult foster care facility. However, it does provide BCAL with information which will be carefully
evaluated by licensing staff. A failure on the part of an applicant to provide BCAL with accurate and truthful information
and the authorization requested on this form may be sufficient cause to deny issuance of a license.
• I am aware that Michigan Department of State Police Records will be checked for information regarding criminal
• I certify that the information I have given on the form is, to the best of my ability, true and correct.
• The Department may perform this check at any time while I am licensed or associated with a licensed facility.
• I understand the personal information and fingerprints submitted by live scan are used to search against criminal
identification records from both the Michigan State Police (MSP) and Federal Bureau of Investigation (FBI). I hereby
authorize the release of any records to the person or agency listed above. I further understand MSP and the FBI may also
retain the submitted information and fingerprints as permitted by the Federal Privacy Act of 1974 (5 USC § 552a(b)) for
routine uses beyond the principal purpose listed above. Routine uses include, but are not limited to, disclosures to:
governmental authorities responsible for civil or criminal law enforcement, counterintelligence, national security, or public
• 28 CFR §16.34- Procedure to obtain change, correction or updating of identification records.
If, after reviewing his/her identification record, the subject thereof believes that it is incorrect or incomplete in any respect
and wishes changes, corrections or updating of the alleged deficiency, he/she should make application directly to the
agency which contributed the questioned information. The subject of a record may also direct his/her challenge as to the
accuracy or completeness of any entry on his/her record to the FBI, Criminal Justice Information Services (CJIS) Division,
ATTN: SCU, Mod. D2, 1000 Custer Hollow Road, Clarksburg, WV 26306. The FBI will then forward the challenge to the
agency which submitted the data requesting that agency to verify or correct the challenged entry. Upon the receipt of an
official communication directly from the agency which contributed the original information, the FBI CJIS Division will make
any changes necessary in accordance with the information supplied by that agency.
**DISCLAIMER: ALL FINGERPRINTS PROCESSED WITH INCORRECT FINGERPRINT CODES OR USE OF THE
WRONG LICENSE RECORD CLEARANCE REQUEST FORM ARE THE RESPONSIBILITY OF THE INDIVIDUAL. MSP
WILL CHARGE FOR SECOND REQUESTS DUE TO INCORRECT FINGERPRINT CODES.
AUTHORITY: 1978 PA 368
Department of Human Services (DHS) will not discriminate against any
individual or group because of race, religion, age, national origin, color,
height, weight, marital status, sex, sexual orientation, gender identity or
expression, political beliefs or disability. If you need help with reading,
writing, hearing, etc., under the Americans with Disabilities Act, you are
invited to make your needs known to a DHS office in your area.
1979 PA 218
CONSEQUENCE: Licensure may be denied.