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Effective Date: 




Updated: 1/2019



This form is used to request a background check.


When to Prepare When must I complete the background check request?

Each person at your operation who is required to have a background check must complete all required background checks prior to having direct access or providing direct care to the children in care.

How does a child care operation submit a background check request?

If your operation is a licensed child care center, school-age program, before- or after-school program, licensed child care home, registered home or residential care provider, your operation must submit your background check requests via the internet.

If your operation is a listed family home, employer-based child care operation or shelter operation, your operation may submit your background check requests via the internet, email the form to, fax the background check request form to 512-339-5871, or mail the background check form to:

Texas Health and Human Services
Commission Centralized Background Check Unit
P.O. Box 149030, Mail Code 121-7
Austin, TX 78714-9030

Transmittal and Fee

Submit background check requests to:

Is there a fee for processing background check requests?

Yes. You must pay a $2 fee for each person listed on this form or submitted via the internet. Submit the appropriate Fee Schedule for your operation, along with the fee(s), to:

Texas Health and Human Services Commission
Accounts Receivable
P.O. Box 149055
Austin, TX 78714-9055

Failure to submit fee payments can result in adverse action including suspension or revocation.

If a fingerprint check is required, a separate fee for obtaining a fingerprint check must be paid to the DPS Fingerprinting Service Center for each person obtaining a fingerprint check at the time of the fingerprinting appointment.

For information on that fee and scheduling a fingerprint-based check, see the Centralized Background Check Unit Fingerprinting page at