Division of Medical Services
Office of Long Term Care Mail Slot S405
P.O. Box 8059
Little Rock, Arkansas 72201-4608
Telephone (501) 682-8487 TDD (501) 682-6789 Fax (501) 682-6955
M e m o r a n d u m
LTC-A-2003-20
TO:(X) Nursing Facilities; (X) ICFs/MR 16 Bed & Over; (X) HDCs;
(X) ICFs/MR Under 16 Beds; (X) RCFs; (X) Interested Parties;
( ) Hospitals & Discharge Planners; (X) DHSCounty Offices;
(X) Assisted Living Level I;(X) Assisted Living Level II
FROM:Carol Shockley, Director, Office of Long Term Care
DATE:June 13, 2003
SUBJECT:Criminal Record Checks – Increase in Fee
______
The Office of Long Term Care has been notified by the Arkansas State Police that the fee for a State criminal record check will increase from fifteen dollars ($15) to twenty dollars ($20) effective July 1, 2003. Attached to this memorandum is a revised DMS-736 form, Request for Criminal Record Check, reflecting the new fee amount. Please start using this new form on all requests that are post-marked on or after July 1, 2003. All requests for criminal records that are post-marked through June 30, 2003 will be accepted with the old fifteen dollars ($15) fee. At this time the fee for the FBI record check remains at twenty-four dollars ($24).
Please use the attached revised DMS-736 form for copy purposes to use for stock supplies of the request form. This form will also be posted on the OLTC website for future needs. The OLTC website can be found at:
If you have questions about the fee increase you may contact Sergeant Cora Gentry or Senior Corporal David Dillinger of the State Police Identification Bureau at 501-618-8500. If you have questions regarding this memorandum or other criminal record check processes, please contact Tommy Wingard at 501-682-6117.
If you need this material in alternative format such as large print, please contact our Americans with Disabilities Act Coordinator at 501-682-8307 (voice) or 501-682-6789 (TDD).
CS/tw
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