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Child Abuse Certification of Exemption Form - op nysed 2026
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- Click ‘Get Form’ to open the Child Abuse Certification of Exemption Form in the editor.
- Begin by filling out your Social Security Number in Item 1. If you do not have one, leave this field blank.
- In Item 2, enter your birth date using the provided format (Month/Day/Year).
- For Item 3, print your name exactly as it appears on your licensure application or registration.
- Complete Item 4 with your N.Y.S. License Number if applicable; otherwise, leave it blank.
- Fill in your mailing address in Item 6, ensuring to notify the Department of any changes promptly.
- Select your profession in Item 7 by checking the appropriate box that corresponds to your license type.
- Finally, sign and date the form at the bottom to attest that you understand the terms and conditions outlined.
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Related links
Use this form only if you are applying for an exemption to the requirement to complete training or coursework in the identification of child abuse andRead more
Feb 1, 2021 This compendium is not intended as guidance from CMS. It does not replace or serve as a substitute for. CMS requirements and policy.Read more