Request for Child Protective Services Background Check for Certain Purposes

The purpose of this form is gather information and authorization to complete a Child Protective Services (CPS) background check from Wisconsin's county administered child protective services data system. CPS information may be released as allowed by Wisconsin Statute Section 48.981(7).

A separate form must be completed for each individual background check request.

You should receive a response from our staff within 10 working days of the date the request was received by our agency. Please do not send a duplicate request. If you have not received contact from our staff within 10 working days after the submission of the form, you may send an inquiry only email to Be sure to include the person's name for which you had initially submitted the background check request.

If you are not an entity listed below, or you are not requesting information based on the criteria listed below, you may be eligible to request other types of background check information and criminal history report from the Wisconsin Department of Justice (DOJ).

*Provision of a Social Security Number (SSN) is voluntary. Not providing it could result in an information processing delay.

Information for individual for which the CPS background check is being requested

Purpose of Request
Purpose of Request

Agency Requesting Contact Information

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