2024 EAFC LE Summit Resource Guide

9 E.A.F.C. Law Enforcment Summit Resource Guide |

Administrative Office 4060 County Circle Drive, Riverside, CA 92503 951.358.3000 FAX: 951.358.3036 www.dpss.co.riverside.ca.us

Charity Douglas, MSSW, DPSS Director Barry L Dewing, Assistant Director, DPSS

Adult Services Division

Adult Protective Services (APS) Custodian of Records Request Form Please complete the form in its entirety in order for a complete records search to be conducted. Note: Per our county policies and procedures, the County of Riverside Custodian of Records redacts Reporting Party information as well as the client’s social security number in order to protect the identity of the client and reporting party. If you need this information, please be sure to request unredacted records with a justification of why they are needed for your investigation.

REQUESTOR INFORMATION

Name/Title:

Date:

Agency/Organization:

Phone:

Email:

Mailing Address:

CLIENT/VICTIM INFORMATION

Full Name:

Other/AKA:

SSN:

DOB:

PERPETRATOR INFORMATION

Full Name:

Other/AKA:

SSN:

DOB:

CASE INFORMATION

APS Reference Number:

Report/Incident Number:

All Related Records

Only Records Related to Case

Unredacted

Allegation(s), Reason for Records:

To submit a Custodian of Records request, please submit a request to ASD_Admin_Support@rivco.org or via fax at (951) 358-5772. Once all information is provided pertaining to the records request, Adult Services will respond to the request within 10 calendar days. Per administrative policy, Custodian of Records requests and responses are done in writing and will be mailed to the address provided. Once the submitted request to COR has been received, you will receive an email confirmation within 2 business days. If you do not receive a response to your records request or would like to arrange an in-person records pick up, please contact ASD_Admin_Support@rivco.org. Dedicated to Supporting and Improving the Health, Safety and Well-being of Individuals and Families DPSS 4898 (08/24) APS Custodian of Records Request Form