Child Abuse Central Index Forms

These forms are for use by government agencies and certain individuals to report information required by law in child abuse cases. If you suspect a case of child abuse in your neighborhood, you should contact your county child welfare agency or your local police department or sheriff's office.

Department of Justice (DOJ) Forms

If you have questions regarding the use of the forms, contact the Child Abuse Central Index (CACI) at: CACI-Inquiry@doj.ca.gov.

• Child Abuse Central Index Inquiry Request for Out-of-State Foster & Adoption Agencies
  Instructions and Form for use by for Out-of-State Foster & Adoption Agencies.
  
  
  • Form BCIA 4057, pdf
  • Instructions, pdf
• Child Abuse Central Index Self Inquiry Request
  For use by citizens who want to request a self inquiry of the Child Abuse Central Index.
  
  
  • Form BCIA 4056, pdf
  • Form BCIA 4056 (Spanish), pdf
• Child Abuse or Severe Neglect Indexing Form
  For use by specified investigating agencies to report to the California Department of Justice.
  
  
  • Form BCIA 8583,.pdf
  • Instructions, pdf
• Facsimile Inquiry for Child Abuse Central Index (CACI) Search
  This form is to be used by authorized Child Welfare Agencies and Law Enforcement only.
  
  
  • Form BCIA 4084. pdf
• Live Scan Applicant Forms
  For use by authorized agencies and nonprofit groups to request criminal background checks for prospective child placement and employment purposes. More information available from the Fingerprint Submissions Program.
  
  
  • Live Scan Forms
• Suspected Child Abuse Report Form
  For use by mandated reporters to notify a reporting agency (local law enforcement, county probation or county welfare department) about suspected cases of child abuse. Also may be used to cross-report to another reporting agency.
  
  
  • Form SS 8572, pdf
  • Instructions, pdf

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California Emergency Management Agency (CalEMA) Forms

The forms below pertain to child abuse. For questions about the forms, contact the California Emergency Management Agency (CalEMA).

• Medical Report: Suspected Child Physical Abuse and Neglect Examination.
  Used by physicians for reporting evidence of child sexual abuse. Form should be used in lieu of DOJ Form 900 for cases of chronic sexual abuse of minors.
  
  
  • CalEMA Form (2-900), pdf
  • Instructions (2-900i), pdf
  • Protocols (2-900p), pdf
• Mandated Suspicious Injury Report.
  
  
  • CalEMA Form (2-920), pdf
  • Instructions (2-920i), pdf

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Reference Materials

• Child Safety Rules

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