How to Complete and Submit the Washington DSHS Background Check Authorization Form

The Washington DSHS background check authorization form, numbered DSHS 09-653, is what you complete to let the Department of Social and Health Services screen your history before you work with or have access to children, juveniles, or vulnerable adults. You fill it out on paper or online, then give the completed form (or your online confirmation code and date of birth) to the employer or program requesting the check. That entity submits it to the Background Check Central Unit (BCCU) through the state’s Background Check System, and BCCU returns the result to them.¹

Paper Form or Online Submission

You have two ways to complete DSHS 09-653. The paper version can be downloaded from the DSHS Background Check Authorization Form page, and the entity requesting your check often keeps copies on hand. The online version is at the BCCU’s Background Check System portal, fortress.wa.gov/dshs/bcs/. DSHS recommends Google Chrome if the online form gives you trouble.¹

If you go online, the system generates a confirmation code after you sign and save. Write it down or screenshot it before you close the browser. You cannot retrieve a lost code, and BCCU staff cannot retrieve it for you. Codes expire 90 days after submission, so hand yours off promptly.¹

What to Have Ready Before You Start

Missing information is the most common reason a check stalls. Pull these together first:

Your full legal name, exactly as it appears on your government-issued ID.
Every former name you have used — maiden names, prior married names, and any legal aliases. Records may be filed under those names.
Your date of birth and Social Security number. These separate you from other people who share your name in criminal databases.
Residential history for the last 36 months. The form asks whether you have lived in any state or country other than Washington during that period; if you have, list each address.²

The Self-Disclosure Section

A large part of the form is self-disclosure. It asks whether any court or state agency has ever issued a final order finding that you abused, neglected, abandoned, or exploited a child, juvenile, or vulnerable adult. It also asks about specific court orders involving domestic violence, sexual abuse, and financial exploitation.²

Answer honestly. BCCU compares what you disclose against what its database searches actually turn up, and discrepancies can lead to denial. Beyond the licensing consequences, knowingly making a false or misleading material statement to a public servant is a gross misdemeanor in Washington, punishable by up to 364 days in jail, a fine of up to $5,000, or both.³ Self-disclosure also works in your favor if the check comes back with something that needs a review; honesty on the form is one of the factors weighed in that review.

Signing the form authorizes DSHS to check your background with any governmental entity and law enforcement agency, and certifies that the information you provided is true. Your results may include prior self-disclosures and fingerprint results already in the DSHS system.²

Handing the Form to the Requesting Entity

You do not send DSHS 09-653 to BCCU yourself. Give the completed paper form, or your online confirmation code together with your date of birth, to the employer or program that asked for the check. They submit the request through the BCS portal, and the system generates a unique inquiry number they use to track status and retrieve results.¹ In limited cases where an entity lacks portal access, paper submissions may be mailed or faxed to BCCU directly.

What BCCU Actually Checks

Once submitted, your authorization runs against several state and federal sources: Washington State Patrol WATCH criminal history records, a WSP fingerprint-based search, an FBI fingerprint-based search, Adult Protective Services findings, and Child Protective Services findings.⁴ BCCU processes roughly 310,000 background checks a year for authorized service providers and DSHS programs.⁵

How Long It Takes

A clean check with no additional research needed comes back within hours. When BCCU has to dig further, it takes longer. As of late March 2026, BCCU was working through pending inquiries (name-and-date-of-birth checks, interim fingerprint checks, and final fingerprint checks) submitted about three business days earlier, with court documents, affidavits, and responses to additional-information requests running about five business days behind.⁶

Fingerprints add the most variability. The FBI aims to process an initial set within 24 hours of receiving them from WSP, and has up to 10 working days to respond to national name-and-date-of-birth requests. If your prints are rejected for poor quality, WSP takes up to two weeks to process resubmitted prints, on top of whatever time it takes you to schedule a reprinting appointment.⁶

If Fingerprints Are Required

Not every position requires fingerprints, but many do, particularly long-term care work involving Medicaid clients. When fingerprinting applies, you must have an appointment scheduled before you can have unsupervised access to clients, and the national FBI fingerprint check must be completed within 120 days of when you start providing care. During that window, you may work as a provisional hire if your Washington State name-and-date-of-birth check came back clear.⁷

Bring your fingerprint appointment form and a valid photo ID to the nearest IdentoGO location, which is the DSHS contracted vendor. You can also use a law enforcement agency instead. The WSP office in Olympia prints applicants in-house and will not reject prints they take themselves, which is useful if you have had rejection issues elsewhere.⁷

If Something in Your Results Looks Wrong

BCCU cannot fix errors that came from outside agencies. You have to go to the source of the record.

For Washington State Patrol records, contact WSP at (360) 534-2000 (press 5 for customer service) or write to 106 11th Ave SW, Suite 1300, Olympia, WA 98501.
For FBI records, contact the FBI Special Correspondence Unit at Criminal Justice Information Services Division, Attention: SCU, Module D-2, 1000 Custer Hollow Road, Clarksburg, WV 26306-0171, or call (304) 625-5590.
For Washington court records, contact the specific court that reported the information.⁸

If a check flags an unclear or unknown crime, work with the reporting agency to send BCCU more detail so it can issue the correct results letter. If that agency is unresponsive and you know what the underlying charge is, fill out a BCCU Applicant Affidavit Form with the exact date and details and send it to BCCU for review. The same affidavit form is used to correct self-disclosures.⁸

To see a copy of your results, ask the entity that requested the check, or submit a Request for Background Check Information Form to BCCU at bccuinquiry@dshs.wa.gov.⁸

1
Washington State Department of Social and Health Services. Background Check Authorization Form
2
Washington State Department of Social and Health Services. DSHS 09-653 – Background Check Authorization
3
Washington State Legislature. Washington Code RCW 9A.20.021 – Maximum Sentences for Crimes Committed July 1, 1984
4
Washington State Department of Social and Health Services. What Information Sources Does BCCU Search When They Do a Background Check?
5
Washington State Department of Social and Health Services. Background Check Central Unit FAQs
6
Washington State Department of Social and Health Services. Turnaround Times
7
Washington State Department of Social and Health Services. Background Checks – Individual Providers
8
Washington State Department of Social and Health Services. I Think There Is an Error, How Do I Correct My Background Check