This blog is dedicated to providing education on the legal stipulations upon Mandated Reporters to report Child Abuse. The best place to begin is to understand what those legal requirements are. Ignorance of them is considered no excuse for not reporting. So, as a trainer in this area, I have found it expedient and efficient to use the reporting stipulations and standards set forth by the Office of the Attorney of the State of California. Below, I have provided the "Guide to Reporting Child Abuse to the California Department of Justice", for 2005. Note: The current California Attorney General is Jerry Brown.
2005
Division of California Justice Information Services
Bureau of Criminal Information and Analysis
Child Protection Program
BILL LOCKYER
Attorney General
About this Guide
This guide is designed as a reference manual to assist individuals responsible for submitting the
Child Abuse Investigative Report to the Department of Justice (DOJ).
The Attorney General’s Child Protection Program (CPP) has prepared this guide to:
• Explain and define statutory requirements and responsibilities.
• Explain how to obtain child abuse information from DOJ.
• Assist agencies in complying with reporting requirements.
The Appendix contains forms used to request and report information; abbreviations, acronyms,
and definitions; and a simplified chart showing how the process works.
Further information is available on the Attorney General website at:
http://www.ag.ca.gov/childabuse/
TABLE OF CONTENTS
INTRODUCTION..............................................................1
REPORTING TO CPP......................................................2
FILLING OUT THE REPORT (SS 8583) .........................3
WHAT TO REPORT.........................................................9
WHAT NOT TO REPORT..............................................10
WHEN TO REPORT ......................................................11
WHERE TO SEND REPORTS ......................................11
RETENTION OF INVESTIGATIVE REPORTS .............12
INQUIRIES TO CPP.......................................................13
APPENDIX
Definitions, Abbreviations, and Acronyms
Forms: SS 8583 - Child Abuse Investigation Report
SS 8583 - Instruction Page
SS 8572 - Suspected Child Abuse Report (SCAR)
SS 8572 - Instruction Page
BCIA 4084 - Facsimile Inquiry
Flowchart
INTRODUCTION
The Child Abuse Central Index (Index) is a tool for state and local agencies to help protect the
health and safety of California’s children. The Index was created by the Legislature in 1965, and is
defined in Penal Code (PC) sections 11164 through 11174.31. These statutes are referred to as
the Child Abuse and Neglect Reporting Act (CANRA).
The Index reflects reports of investigations completed by child protection agencies, and is used to
aid with investigations and prosecutions. Information from the Index is also provided to agencies to
help screen applicants for licensing or employment in childcare facilities and foster homes, to aid in
background checks for child placement and adoptions, as well as peace officer pre-employment
checks.
The CPP administers the Index by processing information extracted from Child Abuse Investigation
Report (Form SS 8583). The CPP updates information to, and disseminates information from, the
Index to authorized agencies.
As a child protective agency investigator, you may contact the CPP to determine if another agency
has submitted a report with information relating to suspects and/or victims in your current
investigation. Likewise, child abuse investigators from other agencies may need information you
have submitted. Therefore, the reports you submit are vitally important throughout California.
The CPP disseminates Index information, including notices of new child abuse investigation reports
involving the same reported suspects and/or victims.
Information on file in the Index includes:
• Names and personal descriptors of the suspects and victims;
• Reporting agency that investigated the incident;
• The name and/or number assigned to the case by the investigating agency;
• Type(s) of abuse investigated; and
• The findings of an investigation for the incident, which are either substantiated or
inconclusive. (See 11165.12 PC)
Each reporting agency is required by law to forward to the DOJ a summary of every child abuse
incident it investigates, unless the incident is determined to be unfounded or of general neglect.
Each reporting agency is responsible for the accuracy, completeness and retention of the
investigative file that substantiates a report submitted to the DOJ.
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REPORTING TO THE INDEX (Form SS 8583)
11169 PC mandates reporting child abuse to the DOJ.
Specifically, 11169 PC states “An agency specified in 11165.9 PC shall forward to the DOJ a report
in writing of every case it investigates of known or suspected child abuse or severe neglect….”
Child abuse investigators who work for police and sheriff’s departments, county welfare
departments, and county probation departments must report to the DOJ all investigated cases of
child abuse:
1) determined not to be unfounded, and
2) mandated by law to be reported (Refer to “What to Report” on page 9).
Reporting to DOJ is done once your investigation is complete.
The DOJ has prepared standardized forms for the reporting of child abuse. To help ensure the
accuracy and completeness of your reports, the following is an explanation of each section of the
Child Abuse Investigation Report (Form SS 8583):
GENERAL INSTRUCTIONS
• For reporting to the DOJ, use current Form SS 8583 only.
• All shaded areas on Form SS 8583 are mandatory fields. Print clearly or type.
• All information blocks should be completed by the Child Abuse Investigator (law
enforcement and/or child protection agencies).
• To allow complete reporting to DOJ, mark “UK” in any field for which information is
unknown or not available.
• Incomplete forms submitted to DOJ may be returned for correction. Ensure
accurate and timely resubmission of forms returned to your agency.
• If you have any questions about completing the Form SS 8583, please contact the
DOJ at (916) 227-3285.
2
FILLING OUT THE FORM SS 8583
Section A. Investigating Agency
(Items in bold are mandatory data elements.)
1. Name and Type of Investigating Agency
Fill in the name of your agency and check box for appropriate type, whether police,
sheriff, welfare or probation.
2. Agency Report Number/Case Number
Fill in your report number and/or the name you’ve assigned to the case.
3. Agency Address
Fill in the complete address of your agency.
4. Agency Telephone and Extension
Fill in either your telephone number and extension number or a number
where an investigator can locate the records.
5. Name of Investigating Party and Title
Fill in your name and title.
6. Date Report Completed
Fill in date of actual completion of Form SS 8583.
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7. Agency Cross-reported to
If cross-reporting was required, fill in the name of the CPA you notified about report
of suspected child abuse.
8. Person Cross-reported to
Fill in the name of the person you notified about report of suspected child abuse.
9. Date Cross-reported
Fill in actual date you notified the CPA about report of suspected child abuse.
10. Action Taken
Only one action per Form SS 8583 can be submitted. The options are;
a) Substantiated finding (abuse more likely than not occurred), or
b) Inconclusive finding (insufficient evidence of abuse, but not unfounded).
10. A. Supplemental information
Use this section if you have previously completed and submitted to DOJ a Form
SS 8583, and you want to report additional significant information. Complete
information blocks 1 through 5 in Section A; and the following pertinent
information blocks pertaining to the additional information:
a) You are modifying your initial findings, or
b) You are reporting additional facts discovered during your investigation
that are significant to the case. Fill in appropriate information blocks on
form (e.g., addition or deletion of suspects or victims). Attach a copy of
the Original Form SS 8583.
11. Active investigation conducted per 11169(a) PC…
(…and if victims, suspect and witnesses were contacted).
In a completed active investigation, the suspects and witnesses would be
contacted and interviewed. If you were unable to notice the suspect of this
investigation, place explanation in the Comments field (A-12).
NOTE: an active investigation is critical and that in order to comply with the
DOJ Regulations, you must complete an active investigation.
12. Comments
If you are submitting a supplemental Form SS 8583, you can describe the reason
for submitting this here.
If you were unable to contact suspect for any reason, enter the reason here.
Please contact the CPP if you have any questions concerning meeting the requirements of
an “active investigation.”
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Section B. Incident Information
(Items in bold are mandatory data elements.)
1. Date of Incident
Fill in date the incident occurred. If you only know the month and year, and not the
date, submit using the following example format: 02/00/1998.
2. Time of Incident
Fill in time the incident occurred.
3. Location of Incident
Fill in address and description of premises where incident occurred.
4. Name of Party Reporting Incident
This is the person who has contacted the CPA to report the suspected abuse.
Remember, if you are the investigating party, you will list that information in Section
A. Law Enforcement and Child Protection Services should not be listed in this
section as the reporting party.
5. Employer
Pertains to person listed in #4.
6. Telephone
Pertains to person listed in #4.
7. Type of Abuse
Check the type of abuse. You may check one or more, as
appropriate. The types of abuse captured are Physical, Mental, Sexual and
Severe Neglect. General Neglect is only listed here and available as a
selection when submitting a supplemental report, if applicable.
8. If Abuse occurred in Out-of Home Care, check type
The types are: Family Day Care, Child Care Center, Foster Family Home,
Small Family Home or Group Home or Institution.
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C. Involved Parties
Victims
(This section allows for the entry of two victims.)
(Items in bold are mandatory data elements.)
Name, A.K.A., DOB, Sex, Race
• Name of Victim: This includes nicknames or other names used, such as maiden
names.
•
DOB: Fill in the victim’s date of birth. (This is important to establish victim as a
minor at the time of the abuse.)
•
Sex: Check appropriate box to indicate whether victim is male or female.
• Race: Refer to race types on bottom of reporting form.
Address: Fill in complete address of victim.
Did victim’s injuries result in death?
Check appropriate box.
Nature of Injuries:
Describe injuries (e.g., broken bones, burns, bruises). If this information is
uncovered once a report has initially been submitted, a supplemental report should
be submitted responding to this question.
Present location of victim:
Fill in victim’s current location, including the phone number.
Is victim Developmentally Disabled?
Refer to Welfare & Institutions Code, section 4512(a) for definition, and check
appropriate box.
6
C. Involved Parties (Continued)
Suspects
(This section allows for the entry of two suspects)
(Items in bold are mandatory data elements.)
Name, A.K.A., DOB, Sex, Race
• Fill in complete name of suspect, including any nicknames or other names used,
such as maiden names. If all, or any part of the suspect’s name is unknown or
not available, indicate by writing “UK.”
• Fill in the complete date of birth of the suspect
• Check appropriate box to indicate whether suspect is male or female.
• Fill in the race of the suspect. Codes appear at the bottom of the reporting form.
Address, Height, Weight, Eyes, Hair, Social Security Number
• Fill in the complete address, height, weight, eye color, hair color and social
security number and drivers license number of the suspect, if known. If not
known, you may provide comments.
Relationship to Victim - Check box the appropriate category:
• parent or stepparent of victim
• brother or sister of victim
• other relative of victim
• friend or acquaintance of victim
• stranger or unknown to victim
Suspect given written notice per 11169 (b) PC
• Respond Yes or No and the date notice given. If notice was not given,
explanation must be provided in Comment field (A –12).
7
C. Involved Parties (Continued)
Other
(This section allows for entry of two additional involved parties.)
• Name, Relationship, Date of Birth or approximate age, Sex, and Race
This section includes anyone else who was involved in the incident, but is
neither a victim nor suspect.
Check here if additional sheet(s) is attached.
At the bottom of the form is a box to check if you are attaching additional
information. If checked, this box alerts CPP staff to look for attachments. If there
are more than two names for any of the above-mentioned areas; an additional page
can be submitted attached to the original SS 8583 report.
Notate the RCN listed on the initial report, and include case number and date of
report.
8
WHAT TO REPORT
11169(a) PC mandates the reporting of specific types of child abuse.
The basic categories of reportable child abuse are sexual, physical, severe neglect and willful
harming or endangering (which includes mental abuse). Listed below are the statutory references
and definitions thereof.
Sexual Abuse as defined in 11165.1 PC includes all of the following:
1. Rape (261 PC and 264.1 PC)
2. Incest (285 PC)
3. Sodomy (286 PC)
4. Lewd and lascivious acts upon body of child under 14 [288(a)(b) PC]
5. Oral copulation [288(a) PC]
6. Penetration of genital or anal openings by foreign object (289 PC)
7. Child molesting (647.6 PC)
8. Certain other sexual acts [11165.1(b) PC] including:
a. Penetration of vagina or anus by penis.
b. Sexual contact between genitals or anus by mouth or tongue.
c. Intrusion into genitals or anus by any object.
d. Intentional touching or genitals or intimate parts to arouse or gratify.
e. Intentional masturbation of perpetrator’s genitals in child’s presence.
9. Sexual Exploitation to include:
a. Sending/bringing into state for sale/distribution matter depicting sexual conduct by
minors (311.2 PC)
b. Employment of minor to perform prohibited acts [311.4 (a) PC]
c. Depicting by film, photograph, videotape, etc. sexual conduct by person under 14
[311.4(a) PC]
d. Aiding, promoting, coercing, etc., a child to perform obscene sexual acts for the purpose
of producing pictorial depictions (311.3 PC)
Physical Abuse as defined in 11165.4 PC includes all of the following:
1. Unlawful corporal punishment or injury (11165.4 PC)
2. Any acts or omissions cited in 273a PC and 273d PC
Severe Neglect as defined in 11165.2 PC
The child’s welfare has been risked or endangered or has been ignored to a point that the child has
failed to thrive. Generally, the standard is that a child has been physically harmed or that a very
high probability exists that acts or omissions by responsible person would lead to physical harm.
Willful harming or endangering (which includes mental abuse) as defined in 11165.3
PC
The infliction of mental/emotional suffering. Although 11166(b) PC allows mandated reporters
discretion of whether or not to report to you, you must still report to DOJ.
Child Death referenced in 11174.35 PC
Report any deaths resulting from physical abuse, evidence of prior physical abuse or severe
neglect. If the death occurs after the initial Form SS 8583 is submitted, you must submit a
supplemental Form SS 8583 indicating the change to your initial report.
9
WHAT NOT TO REPORT
11169(a) PC identifies what may not be reported to DOJ.
Sexual
1. Statutory Rape, as defined in section 261.5 PC, except section 261.5(d) PC .
2. Acts of consensual sexual behavior between children under 14 who are of a similar age; or,
acts of unlawful sexual intercourse (statutory rape) (261.5 PC).
Physical
1. Incidents of accidental injury or injuries.
2. Reasonable force by public school employee to stop violent disturbance or to exercise physical
control. (11165.4 PC, Education Code sections 44807 and 49001)
3. Mutual fights between minors. (11165.6 PC)
Neglect
1. General Neglect, which means that the person responsible for the child’s welfare has failed to
provide adequate care but has not physically injured the child.
2. Fetal abuse. Fetal abuse may include adversely affecting the well-being of an unborn child and
evidence of illegal drugs or alcohol in just-born infant.
Child stealing unless it involves child abuse
Unfounded Reports
Reasons for unfounded reports as defined in 11169 PC, may include false reporting, improbable
incidents, accidents, and events that do not constitute child abuse as defined by law.
If you have not conducted an Active Investigation
“Active Investigation” per DOJ regulations Title 11 California Administrative Code, section 901(a)
means the activities of an agency in response to a report of known or suspected child abuse. For
purposes of reporting information to the Child Abuse Central Index, suspected abuse; Active
Investigation” means the activities of an agency in response to a report of known or suspected child
abuse. For purposes of reporting information to the Child Abuse Central Index, suspected abuse;
conducting interview of the victim(s) and any known suspect (s) and witness(es); gathering and
preserving evidence: determining whether the incident is substantiated, inconclusive, or unfounded;
and preparing a report that will be retained in the files of the investigating agency.
If you have not contacted the suspect
This does not apply if you were unable to locate the suspect or another agency (i.e. law
enforcement) has asked you not to notify the suspect. Please use the Comment field to identify the
reason suspect was not contacted.
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WHEN TO REPORT
Send Form SS 8583 to DOJ after;
a) you’ve made investigative contacts,
b) determined that the child abuse report was not unfounded,
c) confirmed that the suspected abuse or neglect is reportable to the DOJ as stipulated in
previously mentioned statutes,
d) and completed the investigation.
11166(j) PC requires the cross-reporting by phone immediately, and by mail within 36 hours of
receiving a report of suspected child abuse from a mandated reporter or from a citizen. You may
use either Forms SS 8572 or SS 8583 to cross-report.
The 36-hour cross-reporting requirement does not apply to DOJ reporting requirements. For DOJ
reporting purposes, you must submit the required Form SS 8583 once you have completed your
investigation.
WHERE TO SEND THE REPORT
Mail the completed, original Form SS 8583 to:
Department of Justice
Bureau of Criminal Information and Analysis
Child Protection Program
P.O. Box 903387
Sacramento, CA 94203-3870
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RETENTION OF INVESTIGATIVE FILES
Sections 11170 PC and 11169 PC govern the retention of child abuse reports in the
Index and affect the retention of reports by local investigative agencies.
1) Agency Retention Requirements
11169(c) PC establishes a basic requirement for agency retention of information.
“Agencies shall retain child abuse or neglect investigative reports that result in a report filed
with the DOJ for the same period of time that the information is required to be maintained on
the Index… Nothing in this section precludes an agency from retaining the reports for a longer
period of time if required by law.”
2) DOJ Retention Requirements
11170(a)(3) PC allows for a 10 year purge for Inconclusive Reports.
“The Department of Justice shall delete unsubstantiated or inconclusive child abuse
investigation reports from the Child Abuse Central Index after ten years….”
This is true only if the suspect of a report is not linked to a subsequent report. When a suspect
of an Index report is linked to a subsequent report, the ten years commence from the date of
receipt of the most recent report. (Originating agency will be notified via mail, by DOJ, when
this occurs.)
There is no statutory or regulatory authority for the DOJ to purge information from the Index
relating to a child abuse investigation if the finding of that investigation was substantiated.
Therefore, investigating agencies must maintain their investigative files of substantiated child
abuse investigations permanently.
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INQUIRIES TO THE INDEX
11170 PC governs access to Index information.
The Index contains pertinent information from investigated reports of suspected child abuse and
offers information not found in the state criminal history system that are derived from arrest and
conviction data.
Information relayed by us is intended to direct you to information held by other agencies. We do not
conduct investigations and do not have complete investigative files. We are a pointer system to the
agency with the investigative file.
HOW TO ACCESS INFORMATION
There are three ways to request Index information. Authorized agencies may access Index
information via fax, teletype, or US mail.
1. Fax Inquiries
A. Submitting Your Request:
Index inquiries will be processed via facsimile request under the following circumstances:
• Placement Of Child In Emergency Situation
• Care-Taker For Ward Of Court Or Dependent Child*
•
Guardianship*
• Investigation Of Current Allegation Of Child Abuse*
Use Form BCIA 4084 for this purpose. Please indicate if you would like your response returned by
telephone or by fax by circling the appropriate return phone/fax number.
Fax your inquiry request to:
Department of Justice, Child Protection Program
Fax number: (916) 227-5054
(After 4:30 p.m. on weekdays, and weekends and holiday fax requests will be automatically
referred to the DOJ Command Center, which will provide the same service.)
B. Responses To Your Request
Searches resulting in a no match, and those possible matches not requiring confirmation,
will generate a reply within two hours. Replies on inquiries requiring confirmation may be
delayed up to 30 thirty days while DOJ contacts the reporting agency to confirm the
availability and accuracy of the original report.
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C. Obtaining The Form
The Form BCIA 4084 can be faxed to your agency or you may request an electronic copy.
Please contact DOJ/CPP with your electronic mailing address.
* Possible matches with an existing Index record will require confirmation prior to the release of information.
2. Teletype
To access the Index via the California Law Enforcement Telecommunications System (CLETS),
authorized agencies should use the following example as a format:
[Mnemonic for the Department of Justice: DOJ ]
ATTENTION: Child Abuse Unit
SUBJECT: Child Abuse Central Index check for the below listed subjects.
TYPE OF INVESTIGATION: Physical
Name of Subject Sex Race DOB Subject Status
JONES, Dorothy Louise F W 010185 V (Victim)
JONES, William Robert M W 020246 S (Suspect)
JONES, Louise Ann F W 030347 S
REFER: Detective Joe Watkins, Child Abuse Unit Mnemonic YB
AGENCY: Los Angeles County Sheriff’s Office
Responses to teletype requests will be returned via teletype unless otherwise specified.
3. US Mail
Agencies may request information via the US Mail. Complete Form BCIA 4084, and mail to
DOJ/BCIA/CPP, P.O. Box 903387, Sacramento, CA 94203-3870.
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APPENDIX
Definition of Terms
Active Investigation - the activities of an agency in response to a report of known or suspected
child abuse. For purposes of reporting information to the Child Abuse Central Index, the activities
shall include, at a minimum: assessing the nature and seriousness of the known or suspected
abuse; conducting interviews of the victim(s) and any known suspect(s) and witness(es); gathering
and preserving evidence; determining whether the incident is substantiated, inconclusive, or
unfounded; and preparing a report that will be retained in the files of the investigating agency.
A
Automated Child Abuse System (ACAS) - the current system used by DOJ to electronically
store reports of child abuse incidents submitted by investigating agencies. Also known as the
Index and CACI.
Child -person who was a victim under the age of 18 at the time of the alleged abuse.
Child Abuse - is the same term as defined in Penal Code section 11165.6, which states the term
"child abuse or neglect" includes physical injury inflicted by other than accidental means upon a
child by another person, sexual abuse as defined in Section11165.1, neglect as defined in Section
11165.2, the willful harming or injuring of a child or the endangering of the person or health of a
child, as defined in Section 11165.3, and unlawful corporal punishment or injury as defined in
Section 11165.4. "Child abuse or neglect" does not include a mutual affray between minors. "Child
abuse or neglect" does not include an injury caused by reasonable and necessary force used by a
peace officer acting within the course and scope of his or her employment as a peace officer.
Child Abuse Central Index - also known as CACI, Index, and ACAS.
Child Protective Agency (CPA) - is the investigating agency, which includes a police
department, a sheriff’s department, a county welfare department, or a county probation
department.
Child Protective Agency Investigator - is a person employed by a child abuse investigative
agency who is responsible for inquiring into the details of a report of suspected child abuse.
(NOTE: Throughout this guide the use of the term “investigator” shall mean a child abuse agency
investigator.)
Child Protection Program - also known as CPP, is the unit within the DOJ responsible for the
maintenance of the Index.
CLETS - California Law Enforcement Telecommunications System.
Confirmation - the DOJ process of contacting the agency that submitted the report to confirm
that the investigative file is still available and is not unfounded.
DOJ - Department of Justice.
General Neglect - is the same term as used in Penal Code section 11165.2(b) means the
negligent failure of a person having the care or custody of a child to provide adequate food,
15
clothing, shelter, medical aer, or supervision where no physical injury to the child has occurred.
This is not reportable to DOJ.
Inconclusive Report - is the same term as defined in Penal Code section 11165.12(c). This
category was originally termed “unsubstantiated report” and was renamed by Chapter 842 of the
Statutes of 1997 and became effective January 1, 1998. Inconclusive as defined means a report
that is determined by the investigator who conducted the investigation not to be unfounded, but the
findings are inconclusive and there is insufficient evidence to determine whether child abuse or
neglect, as defined in Section 11165.6, has occurred.
Index - is the same term as used in Penal Code section 11170(a). The Index is currently known
as the Automated Child Abuse System (ACAS).
Investigative File or Underlying Investigative File - is the original and supplemental
investigative documents developed by an agency during an investigation of a child abuse incident
and that resulted in a report to DOJ.
Possible Match - this is when DOJ staff have checked a specific name as the result of an inquiry
and has, based on the name and other items of personal description (date of birth, social security
number, driver’s license number, or address), matched that name to an existing report(s) in ACAS.
The match is considered possible because it has not been confirmed absolutely with positive
matching processes such as a fingerprint comparison.
Report - an entry in ACAS reporting the investigation of a suspected incident of child abuse. All
mandatory information as specified in Title 11, section 903 of the California Code of Regulations
must be included for the report to be entered into ACAS.
Severe Neglect - is the same term as used in Penal Code section 11165.2, which states; the
negligent failure of a person having the care or custody of a child to protect the child from severe
malnutrition or medically diagnosed non-organic failure to thrive. "Severe neglect" also means
those situations of neglect where any person having the care or custody of a child willfully causes
or permits the person or health of the child to be placed in a situation such that his or her person or
health is endangered, as proscribed by Section 11165.3, including the intentional failure to provide
adequate food, clothing, shelter, or medical care.
Submitting Agency -the agency that forwarded the completed report on which an ACAS entry
is based.
Substantiated - an investigator has determined based upon evidence that makes it more likely
than not that child abuse or neglect, as defined, occurred. Definition in Penal Code section
11165.12 (b), amended on January 1, 2005.
Suspect - a person who has been designated as a suspect in an agency’s child abuse
investigation and subsequently reported as such to DOJ.
Unfounded - an investigator has determined, based on facts, that there was no child abuse.
Penal Code section 11165.12 states: “unfounded means . . . to be false, to be inherently
improbable, to involve an accidental injury.
Victim - a person who has been designated as a victim in a child abuse investigation report and
subsequently reported as such to DOJ.
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APPENDIX
TO BE TYPED OR PRINTED - PRESS FIRMLY - DO NOT USE FELT PEN
2. NAME: Last First Middle ❒ (1) PARENT/STEPPARENT APPROX. ❒ MALE
❒ (2) SIBLING AGE: ❒ FEMALE
SA
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CHILD ABUSE INVESTIGATION REPORT
To be Completed by Investigating Child Protective Agency
Pursuant to Penal Code Section 11169
(SHADED AREAS MUST BE COMPLETED)
REPORTED:
FOR DOJ USE ONLY
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MO DA YR
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MO DA YR
1. INVESTIGATING AGENCY (Enter complete name and check type): ❒ POLICE ❒ WELFARE 2. AGENCY REPORT NO./CASE NAME:
❒ SHERIFF ❒ PROBATION
3. AGENCY ADDRESS: Street City Zip Code 4. AGENCY TELEPHONE: EXT:
( )
5. NAME OF INVESTIGATING PARTY: TITLE 6. DATE REPORT
7. AGENCY CROSS-REPORTED TO: 8. PERSON CROSS-REPORTED TO: 9. DATE CROSS-
10. ACTION TAKEN (check only one box): 10A. SUPPLEMENTAL INFORMATION (Attach copy of original report)
❒ (1) SUBSTANTIATED (Credible evidence of abuse) ❒ (a) INCONCLUSIVE ❒ (c) ADDITIONAL INFORMATION
❒ (2) INCONCLUSIVE (Insufficient evidence of abuse, not unfounded) ❒ (b) UNFOUNDED (false report, accidental, improbable)
( )
*
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1. NAME: Last First Middle ❒ (1) PARENT/STEPPARENT APPROX. ❒ MALE
❒ (2) SIBLING AGE: ❒ FEMALE
MO DA YR
11. Active investigation conducted per PC 11169(a)? ❒ Yes ❒ No* Victim(s) contacted? ❒ Yes ❒ No* Suspect(s) contacted? ❒ Yes ❒ No* ❒ No Suspects
Witness(es) contacted? ❒ Yes ❒ No* ❒ No witnesses *Explain in comments field A.12.
12. COMMENTS:
1. NAME: Last First Middle AKA APPROX. ❒ MALE
AGE: ❒ FEMALE
ADDRESS: Street City Zip Code DID VICTIM'S INJURIES RESULT IN DEATH? ❒ YES ❒ NO
NATURE OF INJURIES:
PRESENT LOCATION OF VICTIM: TELEPHONE NUMBER: IS VICTIM DEVELOPMENTALLY DISABLED [4512(a) W&I]?
❒ YES ❒ NO
2. NAME: Last First Middle AKA APPROX. ❒ MALE
AGE: ❒ FEMALE
ADDRESS: Street City Zip Code DID VICTIM'S INJURIES RESULT IN DEATH? ❒ YES ❒ NO
NATURE OF INJURIES:
PRESENT LOCATION OF VICTIM: TELEPHONE NUMBER: IS VICTIM DEVELOPMENTALLY DISABLED [4512(a) W&I]?
❒ YES ❒ NO
2. NAME: Last First Middle AKA APPROX. ❒ MALE
AGE: ❒ FEMALE
ADDRESS: Street City Zip Code HGT WGT EYES HAIR SOCIAL SECURITY NUMBER: DRIVER'S LICENSE NUMBER:
RELATIONSHIP TO VICTIM: ❒ (1) PARENT/STEPPARENT ❒ (2) SIBLING ❒ (3) OTHER RELATIVE ❒ (4) FRIEND/ACQUAINTANCE ❒ (5) STRANGER
Suspect given written notice per PC 11169(b)
❒ Yes ❒ No Date notice given: If notice not given, explain in comments field A.12.
1. NAME: Last First Middle AKA APPROX. ❒ MALE
AGE: ❒ FEMALE
ADDRESS: Street City Zip Code HGT WGT EYES HAIR SOCIAL SECURITY NUMBER: DRIVER'S LICENSE NUMBER:
RELATIONSHIP TO VICTIM: ❒ (1) PARENT/STEPPARENT ❒ (2) SIBLING ❒ (3) OTHER RELATIVE ❒ (4) FRIEND/ACQUAINTANCE ❒ (5) STRANGER
Suspect given written notice per PC 11169(b)
❒ Yes ❒ No Date notice given: If notice not given, explain in comments field A.12.
1. DATE OF INCIDENT: 2. TIME OF INCIDENT: 3. LOCATION OF INCIDENT:
4. NAME OF PARTY REPORTING INCIDENT: TITLE: 5. EMPLOYER: 6. TELEPHONE:
7. TYPE OF ABUSE (check one or more): ❒ (1) PHYSICAL ❒ (2) MENTAL ❒ (3) SEXUAL ❒ (4) SEVERE NEGLECT ❒ (5) GENERAL NEGLECT
8. IF ABUSE OCCURRED IN OUT-OF-HOME CARE, CHECK TYPE ❒ (1) FAMILY DAY CARE ❒ (2) CHILD CARE CENTER ❒ (3) FOSTER FAMILY HOME ❒ (4) SMALL FAMILY HOME
❒ (5) GROUP HOME OR INSTITUTION-Enter name and address:
SU
SP
EC
TS
*RACE CODES: W-White, B-Black, H-Hispanic, I-American Indian, F-Filipino, P-Pacific Islander, C-Chinese, J-Japanese, A-Other Asian, Z-Asian Indian, D-Cambodian,
G-Guamanian, U-Hawaiian, K-Korean, L-Laotian, S-Samoan, V-Vietnamese, O-Other, X-Unknown ❒ CHECK HERE IF ADDITIONAL SHEET(S) IS ATTACHED.
SS 8583 (Rev. 5/02) PINK COPY-DOJ; WHITE COPY-Police or Sheriff; BLUE COPY-County Welfare or Probation; GREEN COPY- District Attorney's Office
CHILD ABUSE INVESTIGATION REPORT
DEPARTMENT OF JUSTICE (DOJ) FORM SS 8583
Guidelines for Use and Completion of Form SS 8583
(For Specific Requirements Refer to the Child Abuse Reporting Law, California Penal Code Section 11165 through 11174.5)
For immediate information on potential suspects/victims, please contact the Child Abuse Unit at (916) 227-3285.
Who Must Report
Interagency Reporting
. Any police or sheriff's department, county welfare department, or county
probation department (if designated by thecounty to receive mandated reports)
must report every suspected incident of child abuse it receives to:
. the law enforcement agency having jurisdiction over the case
. the agency responsible for investigations under Welfare and Institutions Code
Section 300
. the district attorney's office
DOJ Reporting
. An agency must report every incident of suspected child abuse for
which it conducts an active investigation and determines not to be
unfounded to DOJ on the Form SS 8583.
NOTE: Reports are not accepted from non-California agencies.
What Incidents Must Not Be Reported
Interagency Reporting
. Incidents specifically exempted under cooperative arrangements with other
agencies in your jurisdiction.
DOJ Reporting
. Unfounded reports - Reports that are determined to be false, to be
inherently improbable, to involve an accidental injury, or not to constitute child
abuse or neglect, as defined in Section 11165.6 PC (Section 11165.12 PC).
. Acts of nonexploitive, consensual sexual behavior between minors under the
age of 14 years who are of similar age.
. Acts of negligence by a pregnant woman or other person(s) which adversely
affect the well-being of a fetus.
. Past abuse of a child who is an adult at the time of disclosure.
. Child stealing, as defined in Sections 277 PC and 278 PC, unless it involves
sexual abuse, physical abuse, mental/emotional abuse, and/or severe neglect.
. Reasonable and necessary force by school employees to quell a disturbance
threatening physical injury to person or damage to property (Section11165.4 PC).
. Statutory rape, as defined in Section 261.5 PC, except Section 261.5(d) PC
(Statutes of 1997).
. Mutual fights between minors (Section 11165.6 PC).
What Incidents Must Be Reported
. Abuse of a minor child, i.e., a person under the age of 18 years, involving any
one of the below abuse types:
Interagency Reporting
. sexual abuse . mental/emotional abuse
. physical abuse . severe neglect
. general neglect
(Refer to Section 11165.1 through 11165.6 PC for citations and definitions)
DOJ Reporting
. All of the above, excluding general neglect.
. Deaths of minors resulting from abuse or neglect.
When Must the Report be Submitted
Interagency Reporting
. Telephone notification - immediately or as soon as practical.
. Written notification - within 36 hours of receiving information
concerning the incident.
. When an agency takes a report for which it lacks jurisdiction the agency shall
immediately refer the case by telephone, fax, or electronic transmission to an
agency with proper jurisdiction.
DOJ Reporting
. A Form SS 8583 must be submitted after an active investigation has been
conducted and the incident has been determined not to be unfounded. DOJ
defines "active investigation" as: the activities of an agency in response to a
report of known or suspected child abuse. For purposes of reporting
information to the Child Abuse Central Index, the activities shall include, at a
minimum: assessing the nature and seriousness of the suspected abuse;
conducting interviews of the victim(s), and any known suspect(s) and
witness(es); gathering and preserving evidence; determining whether the
incident is substantiated, inconclusive or unfounded; and preparing a report
that will be retained in the files of the investigating agency.
NOTE: No other form will be accepted in lieu of the Form SS 8583.
The suspect(s) must be notified in writing that he/she has been
reported to the Child Abuse Central Index per PC Section 11169(b).
What Information is Required
General Instructions
. All information blocks contained on the Form SS 8583 should be completed by the investigating agency. If information is not available, indicate "UNK" in the
applicable information block.
Specific Instructions
. INFORMATION BLOCKS ON THE FORM SS 8583 WHICH ARE SHADED GRAY MUST BE COMPLETED. THE SUBMITTED FORM WILL BE
RETURNED TO THE CONTRIBUTOR WITHOUT FURTHER DEPARTMENT OF JUSTICE ACTION IF THE CONTRIBUTOR FAILS TO COMPLETE ANY
OF THE FOLLOWING ITEMS: the agency name and type, the agency's report number or case name; the action taken by the investigating agency; the specific
type of abuse; the victim's name, birthdate or approximate age, and gender; and the suspect's name and birthdate or approximate age, and gender. If the suspect
is not known, UNKNOWN must be entered. Verification must be provided that an active investigation was conducted, that victim(s), and any known suspect(s),
and witness(es) were contacted. An explanation must be provided if these contacts were not made. Verification must be provided that the suspect was given
written notification that he/she has been reported to the Child Abuse Central Index per Section 11169(b) PC. An explanation must be provided if there was no
notification.
Section A. "INVESTIGATING AGENCY," information block 10. "ACTION TAKEN" or 10A. "SUPPLEMENTAL INFORMATION" must be completed in accordance with the following
definitions (Check one of the boxes):
1 a c
❍ ❍ ❍
10A. SUPPLEMENTAL INFORMATION (Attach copy of original report)
○
○
○
○
○
10. ACTION TAKEN (check only one box):
(1) SUBSTANTIATED (Credible evidence of abuse) ❒ (a) INCONCLUSIVE ❒ (c) ADDITIONAL INFORMATION
❒
(2) INCONCLUSIVE (Insufficient evidence of abuse, not unfounded) ❒ (b) UNFOUNDED (false report, accidental, improbable)
❒
2 b
❍ ❍
10. ACTION TAKEN
❍1 SUBSTANTIATED - Acts determined, based upon some credible evidence, to constitute child abuse or neglect, as defined in Section 11165.6 PC.
❍2 INCONCLUSIVE - Acts determined not to be unfounded, but there is insufficient evidence to determine whether child abuse or neglect, as defined in Section 11165.6 PC,
has occurred.
10A. SUPPLEMENTAL INFORMATION - Only use this section to update information previously submitted on Form SS 8583.
a INCONCLUSIVE - A previously submitted Form SS 8583 indicated as "SUBSTANTIATED" is being reclassified to "INCONCLUSIVE."
❍
b UNFOUNDED - A previously submitted Form SS 8583 indicated as "SUBSTANTIATED," "UNSUBSTANTIATED" or "INCONCLUSIVE" is being reclassified to
❍
"UNFOUNDED."
c ADDITIONAL INFORMATION - Supplementary information is being provided for a previously submitted Form SS 8583.
❍
Where To Send The Report Form SS 8583
(For DOJ reporting only)
Department of Justice
Bureau of Criminal Information and Analysis
P. O. Box 903387
Sacramento, CA 94203-3870
ATTENTION: Child Abuse Unit
REMEMBER
Submit completed Form SS 8583 to DOJ as soon as possible after completion of the investigation because
the case information may contribute to the success of another investigation. It is essential that the report be
complete, accurate and timely to provide the maximum benefit in protecting children and identifying and
prosecuting suspects. If you have questions about DOJ REPORTING or need a victim or suspect name
check, call the DOJ Child Abuse Unit at (916) 227-3285 or CALNET 498-3285.
SS 8583 (5/02)
SUSPECTED CHILD ABUSE REPORT
To Be Completed by Mandated Child Abuse Reporters
Pursuant to Penal Code Section 11166 CASE NAME:
PLEASE PRINT OR TYPE CASE NUMBER:
NAME OF MANDATED REPORTER TITLE MANDATED REPORTER CATEGORY
A
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REPORTER'S TELEPHONE (DAYTIME) SIGNATURE TODAY'S DATE
( )
❒ LAW ENFORCEMENT ❒ COUNTY PROBATION AGENCY
❒ COUNTY WELFARE / CPS (Child Protective Services)
NAME (LAST, FIRST, MIDDLE) BIRTHDATE OR APPROX. AGE SEX ETHNICITY
ADDRESS Street City Zip HOME PHONE BUSINESS PHONE
( ) ( )
NAME (LAST, FIRST, MIDDLE) BIRTHDATE OR APPROX. AGE SEX ETHNICITY
ADDRESS Street
SUSPECT'S NAME (LAST, FIRST, MIDDLE)
City Zip HOME PHONE
( )
BUSINESS PHONE
( )
BIRTHDATE OR APPROX. AGE SEX ETHNICITY
ADDRESS Street City Zip TELEPHONE
( )
REPORTER'S BUSINESS/AGENCY NAME AND ADDRESS Street City Zip DID MANDATED REPORTER WITNESS THE INCIDENT?
❒ YES ❒ NO
ADDRESS Street City Zip DATE/TIME OF PHONE CALL
OFFICIAL CONTACTED - TITLE TELEPHONE
( )
NAME (LAST, FIRST, MIDDLE) BIRTHDATE OR APPROX. AGE SEX ETHNICITY
ADDRESS Street City Zip
PRESENT LOCATION OF VICTIM SCHOOL
PHYSICALLY DISABLED?
❘❒ YES ❒ NO
IN FOSTER CARE?
❒ YES
❒ NO
DEVELOPMENTALLY DISABLED? OTHER DISABILITY (SPECIFY)
❒ YES ❒ NO
IF VICTIM WAS IN OUT-OF-HOME CARE AT TIME OF INCIDENT, CHECK TYPE OF CARE:
❒ DAY CARE ❒ CHILD CARE CENTER ❒ FOSTER FAMILY HOME ❒ FAMILY FRIEND
❒ GROUP HOME OR INSTITUTION ❒ RELATIVE'S HOME
RELATIONSHIP TO SUSPECT PHOTOS TAKEN?
❒ YES ❒ NO
NAME BIRTHDATE SEX ETHNICITY NAME
1. 3.
2. 4.
TELEPHONE
( )
CLASS GRADE
PRIMARY LANGUAGE
SPOKEN IN HOME
TYPE OF ABUSE (CHECK ONE OR MORE)
❒ PHYSICAL ❒ MENTAL ❒ SEXUAL ❒ NEGLECT
❒ OTHER (SPECIFY)
DID THE INCIDENT RESULT IN THIS
VICTIM'S DEATH? ❒ YES ❒ NO ❒ UNK
BIRTHDATE SEX ETHNICITY
OTHER RELEVANT INFORMATION
IF NECESSARY, ATTACH EXTRA SHEET(S) OR OTHER FORM(S) AND CHECK THIS BOX ❒ IF MULTIPLE VICTIMS, INDICATE NUMBER:
DATE / TIME OF INCIDENT PLACE OF INCIDENT
NARRATIVE DESCRIPTION (What victim(s) said/what the mandated reporter observed/what person accompanying the victim(s) said/similar or past incidents involving the victim(s) or suspect)
SS 8572 (Rev. 12/02) DEFINITIONS AND INSTRUCTIONS ON REVERSE
DO NOT submit a copy of this form to the Department of Justice (DOJ). The investigating agency is required under Penal Code Section 11169 to submit to DOJ a
Child Abuse Investigation Report Form SS 8583 if (1) an active investigation was conducted and (2) the incident was determined not to be unfounded.
WHITE COPY-Police or Sheriff's Department; BLUE COPY-County Welfare or Probation Department; GREEN COPY- District Attorney's Office; YELLOW COPY-Reporting Party
1
2
3
4
5
DEFINITIONS AND GENERAL INSTRUCTIONS FOR COMPLETION OF FORM SS 8572
All Penal Code (PC) references are located in Article 2.5 of the PC. This article is known as the Child Abuse and Neglect Reporting
Act (CANRA). The provisions of CANRA may be viewed at: http://www.leginfo.ca.gov/calaw.html (specify ƒPenal Code≈ and search
for Sections 11164-11174.3). A mandated reporter must complete and submit the form SS 8572 even if some of the requested
information is not known. (PC Section 11167(a).)
I. MANDATED CHILD ABUSE REPORTERS
• Mandated child abuse reporters include all those individuals
and entities listed in PC Section 11165.7.
II. TO WHOM REPORTS ARE TO BE MADE
(ƒDESIGNATED AGENCIES≈)
• Reports of suspected child abuse or neglect shall be made by
mandated reporters to any police department or sheriff«s
department (not including a school district police or security
department), the county probation department (if designated
by the county to receive mandated reports), or the county
welfare department. (PC Section 11165.9.)
III. REPORTING RESPONSIBILITIES
• Any mandated reporter who has knowledge of or observes a
child, in his or her professional capacity or within the scope
of his or her employment, whom he or she knows or
reasonably suspects has been the victim of child abuse or
neglect shall report such suspected incident of abuse or
neglect to a designated agency immediately or as soon as
practically possible by telephone and shall prepare and send
a written report thereof within 36 hours of receiving the
information concerning the incident. (PC Section 11166(a).)
• No mandated reporter who reports a suspected incident of
child abuse or neglect shall be held civilly or criminally
liable for any report required or authorized by CANRA. Any
other person reporting a known or suspected incident of child
abuse or neglect shall not incur civil or criminal liability as a
result of any report authorized by CANRA unless it can be
proven the report was false and the person knew it was false
or made the report with reckless disregard of its truth or
falsity. (PC Section 11172(a).)
IV. INSTRUCTIONS
• SECTION A - REPORTING PARTY: Enter the mandated
reporter«s name, title, category (from PC Section 11165.7),
business/agency name and address, daytime telephone
number, and today«s date. Check yes-no whether the
mandated reporter witnessed the incident. The signature area
is for either the mandated reporter or, if the report is
telephoned in by the mandated reporter, the person taking the
telephoned report.
ETHNICITY CODES
IV. INSTRUCTIONS (Continued)
• SECTION B - REPORT NOTIFICATION: Complete the
name and address of the designated agency notified, the date/
time of the phone call, and the name, title, and telephone
number of the official contacted.
• SECTION C - VICTIM (One Report per Victim): Enter
the victim«s name, address, telephone number, birth date or
approximate age, sex, ethnicity, present location, and, where
applicable, enter the school, class (indicate the teacher«s
name or room number), and grade. List the primary
language spoken in the victim«s home. Check the appropriate
yes-no box to indicate whether the victim may have a
developmental disability or physical disability and specify
any other apparent disability. Check the appropriate yes-no
box to indicate whether the victim is in foster care, and check
the appropriate box to indicate the type of care if the victim
was in out-of-home care. Check the appropriate box to
indicate the type of abuse. List the victim«s relationship to
the suspect. Check the appropriate yes-no box to indicate
whether photos of the injuries were taken. Check the
appropriate box to indicate whether the incident resulted in
the victim«s death.
• SECTION D - INVOLVED PARTIES: Enter the requested
information for: Victim«s Siblings, Victim«s Parents/
Guardians, and Suspect. Attach extra sheet(s) if needed
(provide the requested information for each individual on the
attached sheet(s)).
• SECTION E - INCIDENT INFORMATION: If multiple
victims, indicate the number and submit a form for each
victim. Enter date/time and place of the incident. Provide a
narrative of the incident. Attach extra sheet(s) if needed.
V. DISTRIBUTION
• Reporting Party: After completing Form SS 8572, retain
the yellow copy for your records and submit the top three
copies to the designated agency.
• Designated Agency: Within 36 hours of receipt of Form
SS 8572, send white copy to police or sheriff«s department,
blue copy to county welfare or probation department, and
green copy to district attorney«s office.
Alaskan Native 6 Caribbean 11 Guamanian 16 Korean 22 Polynesian 27 White-Armenian
American Indian 7 Central American 12 Hawaiian 17 Laotian 23 Samoan 28 White-Central American
Asian Indian 8 Chinese 13 Hispanic 18 Mexican 24 South American 29 White-European
Black 9 Ethiopian 14 Hmong 19 Other Asian 25 Vietnamese 30 White-Middle Eastern
Cambodian 10 Filipino 15 Japanese 21 Other Pacific Islander 26 White 31 White-Romanian
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