Agency Access Agreement

Steps for Requesting Access to Criminal History Record Information per statutory authority

PLEASE REVIEW ALL STEPS BEFORE PROCEEDING
FAX REQUEST ARE NOT ACCEPTED

PLEASE DO NOT EMAIL THE INCOMPLETE ACCESS AGREEMENT TO AIUHELP@NCSBI.GOV


THE COMPLETE ACCESS AGREEMENT WITH SUPPORTING DOCUMENTS MUST BE SUBMITTED IN STEP THREE FOR YOUR APPROVAL TO BE CONSIDERED

 

Step One  Click the link below to complete the agreement

Non-Criminal Justice Access Agreement – Agreement between NCSBI and requesting agency
 

Complete this agreement in its entirety. Clearly identify which statute you are applying for on page one. Please print or type agency name in paragraph one. Please be sure to have the fourth page notarized and the seal is visible after scanning.

[PLEASE LEAVE BLACK BOX AT THE BOTTOM OF PAGE FOUR "NCSBI OFFICIAL USE ONLY" BLANK]


We cannot advise you on which statute to choose. If you do not know which statute to choose see the following information for assistance:

Health Care Facility :
Contact DHHS/DHSR

Phone: 919-814-6420
Email:   dhhs.cbc.dhsr@dhhs.nc.gov


All other agency types:
Please contact your legal advisor or visit NC General Assembly for more information.

Below is a list of the most commonly requested
  • Senate Bill 41 (122C-80, 131D-40 and 131E-265) - DHHS NOTE: ABCMS IS ONLY COMPATIBLE WITH THE SENATE BILL 41 NCGS 122C-80, 114-19.10, 131D-40 and 131E-265‚Äč.
  • NCGS 143B-943 (Fire and/or EMS)
  • NCGS 143B-945 (City/County Government Employment)
  • NCGS 116-239.12 Lab School
  • NCGS 66-407 – Precious Metals – State and Federal
  • NCGS 160A-304 – Taxi – State and Federal
  • NCGS 143B-932 Specialized Populations - If you are choosing to request access under NCGS 143B-932 Specialized Populations, please submit proof of qualification. Please include articles of incorporation, pamphlets, or a letter explaining what your agency does. Specialized populations is not for licensed healthcare facilities by DHHS/DHSR. Therefore, if you have a license from DHHS/DHSR you will not qualify as a specialized population facility.
  • If not listed above, please be prepared to provide the authority on the request form.
 

Step Two – CRIMINAL HISTORY REGULATIONS INFO FORM


Regulations Form – CHRI authorization form for personnel

Everyone at your agency that will be submitting and/or receiving Criminal History Record Information (CHRI) must SIGN and complete this regulation form in its entirety. This will be all authorized personnel at your facility. The last line on this form is asking for your NCSBI’s Access Agreement number/OCA/ORI please leave this blank. Your agency number will be assigned to you upon final approval.

 

Step Three  Complete Access Request Form


| ATTENTION | YOUR AGREEMENT IS NOT COMPLETE UNTIL YOU COMPLETE AND CLICK SUBMIT IN THE ACCESS REQUEST FORM BELOW.

Before you begin completing this information, please be sure to have the above documentation completed in its entirety and scanned in order to submit your final application. This includes: non-criminal justice access agreement, CHRI form(s), and a copy of your DHHS license (if applicable).  It is recommended that you save all your scanned documents as .pdf or .jpg files.

Click the link below TO COMPLETE YOUR ACCESS AGREEMENT APPLICATION. This link will direct you to another page. The statutory authority requested in this step must match the NCGS on page one of your non-criminal justice agreement.
 
Access Request Form

 

Step Four – Final approval [NO ACTION REQUIRED]

An email will be sent to the primary contact provided on the Access Request Form from the Access Integrity Unit at the NCSBI.

Email will include the following: 


ABCMS compatible agencies (if you requested access per Senate Bill 41 122C-80, 131D-40 and 131E-265) you will be given instructions in the approval email to contact ABCMS at ABCMSSUPPORT@IMPROVING.COM. This email address is the only way for your agency to receive credentials to log into the ABCMS portal.
 

Access Integrity Unit

3320 Old Garner Rd
PO Box 29500
Raleigh, NC 27626-0500
AIUhelp@ncsbi.gov
919-582-8639
 

Billing & Invoices

3320 Old Garner Rd
PO Box 29500
Raleigh, NC 27626-0500
Email: mpettengill@ncsbi.gov
919-582-8552