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Clearance Request


**You do NOT need to complete this form if you are family or friends of inmates seeking to visit with an inmate**
*** Reporters should NOT complete this form.  Instead, please contact the facility's public information officer to obtain the appropriate News Media Relations form or direction.***
Candidates who are not employed by the PA Department of Corrections (DOC), shall request access to a single DOC facility or multiple facilities by completing a Centralized Clearance Information Request Form
This centralized clearance form is not required for family or friends of inmates who are requesting visiting privileges at Department facilities.   Reporters should not complete this form, but should contact the facility’s public information officer to obtain the appropriate News Media Relations form.
All persons who pursue the Centralized Clearance process agree to abide by Department rules as outlined in the 01.01.06 Section 03 Volunteer and Public visitor Information Attachment 3-E.docx and/or any other Department rule as regulated by each respective facility. The candidate assumes all risks which may result from the normal operation of a Department facility.  
The candidate must specify the name of each facility that he/she anticipates traveling to during the clearance period. Clearance periods may be granted up to a maximum of two years for designated Contract Service Providers or Volunteers. All other candidates requesting access may be processed for a maximum of one year. 
Although “Statewide Clearance” is one of the options on the form, approval for this level will only be granted when access is required at every Department facility, otherwise, "Multi-Facility" should be selected and each facility identified. If originally approved for a specific number of facilities, additional institutions may be added during the clearance period when approved by the added facility’s Security Office. 
It is the candidate's responsibility to renew their clearance by submitting a new Centralized Clearance Information Request Form prior to the expiration of the approved clearance period to ensure continued access.
The candidate shall legibly complete all fields in Section "A". "N/A" should be indicated in fields that do not apply. Incomplete forms will be rejected. The candidate must disclose active relationships with DOC inmates. Candidates are required to sign and date this form, validating all information on the document. Omission or falsification of pertinent information will be grounds for disapproval of the requested clearance. Third parties may not fill out forms on the candidate's behalf without the candidate's validation of the final document. If additional space is needed, the candidate may use additional paper. Completed forms should be hand delivered, mailed, or confidentially transmitted to the Department of Corrections representative/moderator. Since the Department recognizes that these forms contain restricted/protected information, completed forms should not be faxed via unsecured fax machines.
The DOC staff member who is endorsing the candidate's clearance request, will review the submitted form, then complete Section "B". The DOC staff member will validate the nature of the candidate’s request and the duration of the anticipated access period. This original form will then confidentially be forwarded to the facility Security Office or the Centralized Clearance Unit. Copies shall not be retained by the sponsoring staff member.
The Department staff member sponsoring the candidate will receive notice of the clearance decision. All information shall be confidentially maintained in accordance with DOC policy and state regulations.