Cy104 2026

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The document is a report form for county agency workers to notify law enforcement of suspected child abuse cases, particularly those involving homicide, sexual abuse, or serious bodily injury. It outlines the requirements for reporting such incidents, including necessary information about the child, alleged perpetrator, and circumstances of the abuse. The form also emphasizes the importance of confidentiality and requests feedback from law enforcement on the investigation's outcome.

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Click ‘Get Form’ to open the cy104 in the editor.
Begin by entering the date the report was received by the county agency in the designated field.
Fill in the name and address of the county agency sending the report, along with the signature of the county agency worker.
Provide identifying information for the child, including their name, birthdate, sex, and social security number.
Complete sections regarding parental information by filling in details for both mother and father, including names, birthdates, addresses, and social security numbers.
Document details about the alleged perpetrator and specify their relationship to the child.
Indicate where the abuse occurred and select appropriate reasons for referral from provided options.
Finally, include a narrative describing the nature and extent of suspected abuse in section 16.

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Which of the following are mandated reporters?

Any person who has assumed full or intermittent responsibility for care or custody of an elder or dependent adult, whether or not that person receives compensation, including administrators, supervisors, and any licensed staff of a public or private facility that provides care or services for elder or dependent adults

Who is a mandated reporter in PA?

Who is a mandated reporter? Employees of a health care facility or providers licensed by the Department of Health who are engaged in the admission, examination, care, or treatment of individuals. Employees of child care services who have direct contact with children in the course of employment.

What is mandated reporting for adults in PA?

Mandatory Reporting If the abuse involves serious injury, sexual abuse or suspicious death, reporters must also call police and the Pennsylvania Department of Aging at 717-783-6207. In addition, the reporter may also call the Pennsylvania Department of Health Nursing Home Complaint Line at 800-254-5164.

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What is not considered a mandated reporter?

If your paid job duties require you to directly supervise children, you are a mandated reporter. Otherwise, you are not. Volunteers at DV programs are never mandated reporters, this includes volunteers whose regular, paid work does make them mandated reporters.

What are the four types of mandatory reporters?

Mandated Reporters in California A 5-Minute Legal Guide teachers, social workers, police officers and. clergy.

Cy104 2026

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