What is an Annual Criminal History Record Check Statement (OMR Form 109)?
Every agency, registered provider and provider of services must submit an annual criminal history record check statement to OMRDD. The Chief Executive Officer of an agency/registered provider/provider of services must provide a sworn statement that the agency/registered provider/provider of services is in compliance with the provisions of 14 NYCRR section 633.22. In the case of a registered provider that does not have a Chief Executive Officer in its local area, then the person designated by the registered provider to have primary responsibility for its local operations must provide the sworn statement. This statement must be filed with the Criminal Background Check Unit by April 1 of each year. A roster of employees and volunteers who are subject parties and a list of staffing assignments as of the last day in February of the current year must be submitted with the sworn statement. Penalties for failure to comply with regulations or failure to submit this sworn statement in a timely f
