This form is for law enforcement officials to request confidential Adult Protective Service records.
By completing this form you are attesting that:
- You are a law enforcement official as defined in 45 CFR § 164.103;
- This requested information is relevant and material to a legitimate law enforcement inquiry and necessary in the performance of official functions relating to abuse, neglect or exploitation of an adult 65 years of age and older, or an adult over 18 with a disability;
- This request is limited and specific in scope; and
- De-identified information could not reasonably be used
A law enforcement official defined in 45 CFR § 164.103 means an officer or employee of any agency or authority of the United States, a State, a territory, a political subdivision of a State or territory, or an Indian tribe, who is empowered by law to:
- Investigate or conduct an official inquiry into a potential violation of the law; or
- Prosecute or otherwise conduct a criminal, civil, or administrative proceeding arising from an alleged violation of law.