Federal Background Check Pilot Program Pilot Background Check Process

General Information:

The background check process may stop at any of the 7 steps below if disqualifying information is found.

Providers check state and federal background check results against:

• Wisconsin Offenses List (exit DHFS; PDF, 32 KB), and
• OIG Exclusion List (PDF, 20 KB) - If you have questions about this list, contact Robin Schneider, OIG Attorney, at 202-205-0565.

Refer Caregiver questions to the Applicant Fact Sheet, PDE 1102 (PDF, 29 KB).

• Spanish Version (en Español - Hoja de información del Solicitante) PDE 1102S (PDF, 37 KB)

Step 1: Caregiver completes the form F825064 Background Information Disclosure (BID)

• Forms/Links: Background Information Disclosure (BID) form ( PDF, 43 KB)
• Compliance: Does the BID disclose any offenses that bar employment? A person with a "clean" BID is allowed to work under supervision pending the completion of the background check process.
• Documentation: Keep the signed BID on file.

Step 2: Employer checks free registries

• Forms/Links:
  a. Wisconsin Nurse Aide Registry (aka Caregiver Misconduct Registry) (exit DHFS).
  b. US DHHS Office of Inspector General (OIG) Exclusion Program (exit DHFS)
  c. List of State Nurse Aide Registries (exit DHFS; PDF, 47 KB), if the person has resided outside of WI, check the state registries in the states where they lived
• Compliance: Did any of the checks uncover disqualifying information?
• Documentation: Print web pages or note to file with date and result of registry checks.

Step 3: Employer completes name-based Caregiver Background Check. Make sure to check the box "Is this background check for the DHFS caregiver fingerprint pilot?" when doing background checks related to the pilot. Contact Rebecca Swartz if you do not see the check box.

• Forms/Links: Wisconsin Criminal History Record Check (exit DHFS)
• Compliance: Did the WI Caregiver Background Check uncover disqualifying information either on the criminal history or the DHFS letter?
• Documentation: Print out results and keep in file:
  a. Response from the WI Department of Justice Criminal History Record Request name search either a criminal history or "no record found"; and
  b. A letter from the Department of Health and Family Services that reports the status of a caregiver's administrative findings or licensing restrictions
• Resources:
  • Wisconsin Criminal History Customer Account Application (exit DHFS; PDF, 42 KB)
  • Interpreting Responses (exit DHFS; PDF, 323 KB) - Tips on reading a WI DOJ criminal history response
  • Other states' contact list for criminal histories
  • DOJ's Online Record Check System (exit DHFS; PDF) - Tips on using the on-line record check system

Step 4: Caregiver signs Authorization for Release of Federal Bureau of Investigation (FBI) Information and employer assists with arrangements for fingerprinting.

• Forms/Links: Authorization for Release of FBI Information (PDF, 66 KB)
• The FBI requires that individuals sign the Release of FBI Information prior to being fingerprinted. Providers may put this release on their own letterhead.
• Compliance: Did the Caregiver sign the FBI Release?
• Documentation: Keep a copy of the signed Authorization for Release in file.
• Resources: DOJ Cover Letter (PDF, 124 KB). Employer may share this with Caregiver if useful.

Step 5: Caregiver attends fingerprint appointment. Caregiver must bring a government-issued photo identification card and a copy of the fingerprint registration form to the appointment.

• Compliance: Did Caregiver get fingerprinted?

Step 6: Employer queries DOJ Criminal History website for state and federal fingerprint background check results. Results should be available 1-2 business days after the caregiver is fingerprinted.

• Forms/Links: Wisconsin Criminal History Record Check (exit DHFS)
• Compliance: Did the fingerprint background check uncover disqualifying information either on state or the national criminal history?
• Documentation: Print out results and keep in file:
  a. Response from the WI Department of Justice Criminal History Record Request fingerprint search either a criminal history or "no record found"; and
  b. Response from the FBI fingerprint search either a criminal history or "no record found"; and

Step 7: Employer makes final hiring decision (caregiver may have been provisionally hired for 60 days pending the completion of the background check process)

• Compliance: Ensure that no one is hired with an offense on either the WI Offenses list or Federal Exclusion List.
• Documentation: Documentation from steps 1-6

Last Revised: August 20, 2008