CJIS 9004, Request for Exemption from Mandatory Electronic Fingerprint Submission Requirement. Request for Exemption from Mandatory Electronic Fingerprint Submission Requirement - files medi-cal ca-2026

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by entering your name in the designated fields: last name, first name, and middle name. Ensure that all information is typed clearly to avoid processing delays.
  3. Next, fill in your address details including street, city, county, state, and zip code. Double-check for accuracy.
  4. In the 'Basis for Exemption' section, select the appropriate reason for your exemption request. If you have no regional access to fingerprinting services, provide the nearest electronic fingerprint site information.
  5. If applicable, explain any other reasons for your exemption request in the provided space.
  6. Finally, sign and date the form at the bottom. This certifies that all information provided is true and correct.

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