Fillable Request for Child Abuse and Neglect Information System

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Request for Child Abuse and Neglect Information System

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04MP077E
2/7/2020
Page 1 of 5
Request for Child Abuse and Neglect
Information System Search (CANIS)
for Guardianship
Instructions
Complete the following form to request a search of the Child Abuse and Neglect Information System
(CANIS) for a prospective guardian of a child not in DHS custody. The search and report of CANIS
information is provided to assist in evaluating the safety of the home in which a child is placed.
A timely completed search requires that:
all applicable information regarding the applicant is provided, including all current and former
names used by the applicant;
all applicable information regarding other adults in the household is provided, including all
current and former names;
the applicant has signed the form; and
the form and verification of guardianship petition/filing is transmitted by:
secure email to: canisguardianship@okdhs.org
fax to: 405-325-2321 or
mail to:
Oklahoma Department of Human Services
Child Welfare Services - Statewide Hotline LOC# 100-B
Child Abuse and Neglect Information System
P.O. Box 25352
Oklahoma City, OK 73125
This request will not be completed when required verification is not included.
Results are returned to the requesting court or the court listed in the filing. Results are not returned
to any attorney or individuals requesting guardianship. Provide mail or email address for the court:
Contact CANIS Guardianship at 405-325-2481 if you have any questions.
Please allow up to four weeks for processing the search request.
04MP077E
2/7/2020
Page 2 of 5
Oklahoma Department of Human Services (DHS) is requested to conduct a Child Abuse and
Neglect Information System search for the guardianship applicants named below.
Guardianship applicant full name
Aliases, including maiden name, former married name, and all other names
Date of birth Social Security number Phone number
Address
City
State
ZIP code
Mailing address, if different than residence
City
State
ZIP code
Years at current residence:
Previous county of
residence:
Previous street address
City
State
ZIP code
Dates
resided
Previous street address
City
State
ZIP code
Dates
resided
Previous street address
City
State
ZIP code
Dates
resided
I certify that a guardianship is being pursued through Case Number ,
Judge , County Court. The search report is used for
this purpose only. I further certify under penalty of perjury under the laws of the State of Oklahoma
that the foregoing is true and correct to the best of my information and belief.
Applicant signature Date
Request
Guardianship Applicant One
Unsworn Declaration Under Penalty of Perjury
04MP077E
2/7/2020
Page 3 of 5
Guardianship applicant full name
Aliases, including maiden name, former married name, and all other names
Date of birth Social Security number Phone number
Address City
State
ZIP code
Years at current residence:
Previous county of residence:
Previous street address
City
State
ZIP code
Dates resided
Previous street address
City
State
ZIP code
Dates resided
Previous street address
City
State
ZIP code
Dates resided
I certify that a guardianship is being pursued through Case Number ,
Judge , County Court. The search report is used for
this purpose only. I further certify under penalty of perjury under the laws of the State of Oklahoma
that the foregoing is true and correct to the best of my information and belief.
Applicant signature Date
Guardianship Applicant Two
Unsworn Declaration Under Penalty of Perjury
04MP077E
2/7/2020
Page 4 of 5
Full name
Aliases, including maiden name, former married name, and all other names
Date of birth Social Security number Phone number
Address City
State
ZIP code
Years at current residence:
Previous county of residence:
Previous street address City
State
ZIP code Dates resided
Previous street address City
State
ZIP code Dates resided
Previous street address City
State
ZIP code Dates resided
Full name
Aliases, including maiden name, former married name, and all other names
Date of birth Social Security number Phone number
Address City
State
ZIP code
Years at current residence:
Previous county of residence:
Previous street address
City
State
ZIP code
Dates resided
Previous street address
City
State
ZIP code
Dates resided
Previous street address
City
State
ZIP code
Dates resided
+
Other Adults in the Household
04MP077E
2/7/2020
Page 5 of 5
Full name
Aliases, including maiden name, former married name, and all other names
Date of birth Social Security number Phone number
Address City
State
ZIP code
Years at current residence:
Previous county of residence:
Previous street address
City
State
ZIP code
Dates resided
Previous street
address
City
State
ZIP code
Dates resided
Previous street address
City
State
ZIP code
Dates resided
Note
For a guardianship, the court must have a background check for a prospective guardian and all
other household members 18 years of age and older consisting of a review of national fingerprint-
based criminal background search or an Oklahoma State Bureau of Investigation name-based
criminal history background check, a search of the Sex Offenders Registry maintained by the
Department of Corrections (DOC), and a CANIS search.
A prospective guardian can request national fingerprint-based criminal background search directly
from the Federal Bureau of Investigation (FBI) by applying online at: https://www.fbi.gov/services/
cjis/identity-history-summary-checks#Submit-a%20Request%20to%20the%20FBI.
A search of the Sex Offenders Registry maintained by DOC can be accessed online at: https://
sors.doc.state.ok.us/svor/f?p=119:1.
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Request for Child Abuse and Neglect Information System

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Completed 20 May 2021

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