How to Complete SC DSS Form 1081: Noncriminal Justice Applicant Privacy Rights

SC DSS Form 1081 is a one-page acknowledgment that a South Carolina Department of Social Services agency or facility gives you before submitting your fingerprints for a national criminal history check. Signing it confirms you were told your rights under the federal Privacy Act of 1974 and 28 CFR 50.12. It is not a release, not a consent to run the background check, and not an application for anything. The actual authorization to fingerprint you comes from the foster care, adoption, employment, or licensing paperwork you signed separately.1South Carolina Department of Social Services. DSS Form 1081 – Noncriminal Justice Applicant’s Privacy Rights

When You’ll Be Handed This Form

You receive Form 1081 any time a South Carolina agency starts a fingerprint-based FBI background check on you for a noncriminal justice purpose. The form itself lists employment, professional licensing, immigration and naturalization matters, security clearances, and adoption as the covered situations.1South Carolina Department of Social Services. DSS Form 1081 – Noncriminal Justice Applicant’s Privacy Rights On the DSS side, that usually means prospective foster parents, adoptive parents, child care facility staff, and DSS employees in positions requiring a background check.

The agency or facility running the check is responsible for giving you the form. You don’t need to download it, print it, or bring one with you. The current version is dated April 2025 and is labeled “DSS Form 1081 (APR 25).” It isn’t posted on the DSS public forms list, because it’s meant to be handed to you in person as part of the fingerprinting appointment.2South Carolina Department of Social Services. Forms and Brochures

How to Fill Out Form 1081

The body of the form is preprinted. You are only completing the signature block. There are six fields:

  • Agency/Facility Name — the county DSS office or licensed child-placing agency requesting the check. Usually pre-filled.
  • Applicant Name (Printed) — your full legal name, matching the name on the fingerprint card.
  • Agency/Facility OCA/CC Number — the Originating Agency Case or Contributor Case number assigned by the requesting entity. Pre-filled by the agency; you are not expected to supply it.
  • Applicant Signature — your handwritten signature, confirming you have read and understand the privacy rights on the form.
  • Agency/Facility Address — the physical address of the requesting agency. Usually pre-filled.
  • Date — the date you sign.

If any agency field is blank when the form reaches you, ask staff to complete it before you sign. Your signature records that this specific agency notified you on this specific date, and a signed form with no agency identified is harder to trace later if a question comes up about the check.1South Carolina Department of Social Services. DSS Form 1081 – Noncriminal Justice Applicant’s Privacy Rights

What the Form Tells You About Your Rights

Before you sign, read what the preprinted text actually covers. It describes four protections you have whenever your fingerprints are run through the FBI’s national criminal history database:1South Carolina Department of Social Services. DSS Form 1081 – Noncriminal Justice Applicant’s Privacy Rights

  • You are entitled to see the FBI’s Privacy Act Statement, which explains why fingerprints are being collected, under what authority, and how the resulting records can be used. The form footnotes a direct link at fbi.gov/services/cjis/compact-council/privacy-act-statement.
  • If the check returns information you believe is wrong or incomplete, you can request a correction.
  • Separate from requesting a correction, you can formally challenge the accuracy of your criminal history results, which triggers review by the agency that originally contributed the questioned record.
  • The results can only be used for the stated noncriminal justice purpose. The requesting agency can’t repurpose them for an unrelated matter.

What Happens After You Sign

The requesting agency keeps the signed form. You don’t mail it anywhere. Before you hand it back, take a photo of the completed form or ask for a copy. If a dispute arises later about the background check, your own copy proves which agency initiated the check, when it happened, and that you were notified of your rights.

The fingerprint results go back to the requesting agency, not to you. If the check reveals a record and the agency plans to take an adverse action against you — denying a foster care application, for example — you are entitled to see the results and to dispute anything inaccurate before a final decision is made.

If the Background Check Comes Back Wrong

Inaccurate results can mean a record belonging to someone else, a dismissed charge still showing as open, or outdated information that should have been purged. The correction process has two stages.

Start with the agency that originally submitted the record to the FBI’s database, usually a local police department or court clerk. Ask them to update or correct it at the source. If the originating agency refuses, or if the correction doesn’t flow through to the FBI’s copy, you can challenge the record directly through the FBI’s Criminal Justice Information Services (CJIS) Division. The relevant federal regulations are cited in the form’s footnotes at 28 CFR 20.21(c) and 20.33(d).1South Carolina Department of Social Services. DSS Form 1081 – Noncriminal Justice Applicant’s Privacy Rights

While a challenge is pending, the requesting agency should not treat the disputed record as final. That can slow an application, but it keeps you from losing an opportunity based on a record that turns out to be someone else’s or already resolved.

Not to Be Confused With Other DSS Forms

Because the form number circulates without context, Form 1081 is sometimes mistaken for a DSS release-of-information form. It isn’t one. DSS Form 3072, “Consent to Release Information,” is the document that authorizes DSS to search its Central Registry of Child Abuse and Neglect and share the results. Form 3072 requires a witness signature or notarization and is used in foster parent and adoptive parent screening.3South Carolina Department of Social Services. DSS Form 3072 – Consent to Release Information A foster or adoption applicant typically signs both: Form 1081 for the FBI fingerprint check notification, and Form 3072 for the state child abuse registry search. One does not substitute for the other.

Benefits applicants don’t encounter Form 1081 at all. For SNAP, TANF, and similar programs, DSS verifies income and employment by direct contact with employers and financial institutions under South Carolina Code § 43-5-70, using consent forms built into the application packet.4South Carolina Legislature. South Carolina Code Section 43-5-70