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Livescan Request Form

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LIVESCAN REQUEST FORM

This Livescan Request Form authorizes the taking and electronic submission of fingerprints and associated personal identifying information to authorized criminal history repositories for purposes identified below. The applicant acknowledges that the information provided is true and correct and consents to the transmission and retention of fingerprint images for processing and record-keeping by the requesting agency and criminal justice repositories.

Requesting Agency Information

ORI / Agency Code:

OCA / Billing No.:

Agency Contact Phone:

Purpose and Transaction

Purpose of Submission (check all that apply):

Applicant Information

Date of Birth:

Sex:

SSN:

Phone:

Driver's License / ID No.:

Issuing State:

Email:

Livescan Transaction Details

Technician Name:

Transaction Control No.:

Appointment Date/Time:

Fees and Billing

Enter fee amounts below. All amounts in U.S. dollars. Applicant must remit any fees due at time of service unless billing arrangement is provided.

Service Fee: $

State DOJ Fee: $

FBI Fee: $

Total Due: $

Payment Method:

Certification, Consent and Authorization

By signing below, I certify under penalty of perjury that the information I have provided on this form is true and complete. I authorize the taking of my fingerprints and the submission of my fingerprints and identifying information for processing by criminal justice repositories and requesting agencies for the purposes indicated. I understand that records obtained may be used by the requesting agency in determining suitability for employment, licensing, certification, volunteering, or other permissible purposes. I acknowledge that falsification of any information may subject me to criminal or administrative penalties.

Applicant Printed Name:

Signature:

Date:

Official use only — Technician affirms that identity verification was performed and fingerprints were captured in accordance with procedures. Technician shall retain a copy of this form with the transaction record.

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What the Livescan Request Form Is and When It’s Used

A Livescan Request Form is a standardized document used to collect applicant identifying data and authorize electronic fingerprint capture for criminal-history checks. It records full legal name, date of birth, address, reason fingerprinted, agency ORI or agency name, and other identifiers needed by state and federal criminal history repositories. Agencies, employers, licensing boards, and service providers submit the completed form to a Livescan vendor who captures fingerprints electronically and forwards them to the appropriate criminal history repository for processing. The form serves as the official authorization to transmit biometric data and must comply with state-specific rules governing fingerprint submissions.

Why a Correctly Completed Form Matters

A properly completed Livescan Request Form ensures accurate routing of fingerprints, reduces processing delays, and documents applicant consent. It aligns collected data with repository requirements and minimizes rejections caused by missing ORI codes, incorrect personal information, or incomplete transaction details.

Why a Correctly Completed Form Matters

Typical Parties That Prepare or Submit Livescan Requests

Employers, licensing boards, government agencies, background-screening vendors, and applicants typically prepare or submit a Livescan Request Form for fingerprint-based checks.

  • Employers conducting pre-employment and periodic background checks for safety-sensitive or regulatory positions.
  • State licensing boards requiring fingerprint-based criminal history for initial licensing or renewals.
  • Law enforcement and government agencies requesting fingerprints for appointments, clearances, or special assignments.

Select the correct transaction type and agency ORI before submission to avoid reprocessing and additional fees.

Who Signs and Who Approves the Form

Hiring Manager

A hiring manager requests the Livescan Request Form to authorize fingerprint-based background checks. They verify applicant identity, provide accurate ORI or agency codes, confirm payment arrangements, and ensure the results are returned to the correct organization to avoid processing errors or delays.

Licensing Official

A licensing official completes or authorizes the form for credential applicants. They supply the agency ORI, transaction reason code, and any fee waiver details, confirming statutory requirements for fingerprint submissions under applicable state licensing regulations.

Required Data Elements on a Livescan Request Form

Full Legal Name: Enter exact name as shown on government-issued ID.
Date of Birth: Use MM/DD/YYYY format; required for identity matching.
SSN or TIN: Provide full SSN or last four, per agency instructions.
Current Address: Include street, city, state, and ZIP code.
ORI / Agency Code: Enter the agency ORI exactly; wrong ORI misroutes results.
Reason Fingerprinted: Select transaction code or give statutory reason required.

Consequences of Errors or Omissions

Incorrect ORI: Results misrouted; re-submission likely.
Missing Signature: Submission rejected by repository.
Wrong DOB: Identity mismatch delays processing.
Incomplete Form: Processing halted until corrected.
FCRA Violations: Applicant rights may be infringed.
Late Submission: May incur additional fees or denials.

Common Pitfalls to Avoid

  • Using a nickname or informal name instead of the applicant’s full legal name leads to fingerprint mismatches and delays at the repository level.
  • Entering the wrong ORI or transaction code is a frequent cause of returned or misrouted results; confirm codes with the receiving agency before submission.
  • Failing to include required payment or fee-waiver documentation can result in an immediate rejection or hold on processing by the Livescan vendor.
  • Not collecting a written consent or failing to show proof of identity can create compliance exposure under FCRA or state privacy laws.

Step-by-Step: Completing a Livescan Request Form

Follow these sequential tasks to prepare a complete Livescan Request Form and reduce the chance of rejection.

  • 01
    Verify Identity: Confirm applicant ID against government-issued documents.
  • 02
    Enter Applicant Data: Fill every required field precisely, including DOB and SSN/TIN.
  • 03
    Provide ORI: Insert the exact agency ORI and transaction reason code.
  • 04
    Sign and Submit: Obtain applicant signature, then send to Livescan vendor.

How the Livescan Submission Process Operates

A typical Livescan workflow moves from form completion to electronic fingerprint capture and repository reporting; each step creates an auditable event.

  • Form Preparation: Complete and verify all identity and ORI fields.
  • Fingerprint Capture: Livescan technician captures electronic prints and transmits data.
  • Repository Processing: State or federal repository compares prints and returns results.
  • Results Delivery: Agency or employer receives the criminal-history response.

Key Sections to Include on a Professional Livescan Request Form

A complete Livescan Request Form groups applicant identifiers, transaction details, payer information, and consents so repositories and vendors can process fingerprints without additional clarifications.

Applicant Identification

Collect full legal name, alias names, date of birth, place of birth if required, gender, and SSN or last four to ensure accurate biometric matching and reduce false positives.

Contact Information

Provide current mailing address, phone number, and email so the agency or vendor can request clarifications or return printed receipts and notifications securely.

Agency ORI Details

Record the receiving agency’s ORI or agency code and the exact transaction reason code so fingerprint transmissions are routed correctly to the intended criminal history repository.

Billing and Fees

Specify who pays processing fees, fee waiver status, credit card or invoicing details if applicable, and whether the submission is for employment, licensing, or another statutory purpose.

Consent and Acknowledgment

Include a clear consent statement authorizing electronic capture and transmission of fingerprints, plus applicant initials or signature confirming receipt of required disclosures.

Signature Block

Provide dated signature lines for the applicant and, where required, an authorized official; unsigned forms are commonly rejected by recipients and repositories.

Recommended Digital Workflow Settings for Online Completion

Configure an online form to validate critical fields, capture consent, and attach proof-of-identity to prevent common rejections.

Field Configuration
Full Name Field Required; no special characters allowed
DOB Field Date picker MM/DD/YYYY required
ORI Field Exact-match validation against known ORI list
Signature Field Capture digitally with timestamp and IP

Digital Submission and Platform Considerations

Use a platform that supports secure upload, audit trails, and conditional fields to match Livescan vendor and agency requirements before submission.

  • File Types: PDF and DOCX widely accepted by vendors.
  • Integrations: Common integrations: HRIS, background-check vendors.
  • Security: Use TLS in transit and AES-256 at rest.

Processing Time Expectations and Key Deadlines

Processing times vary by state and repository; plan for agency-specific waits and confirm turnaround with the Livescan provider before scheduling.

Same-Day Responses:

Many repositories return results within 24–72 hours.

Delayed Matches:

Identity mismatches can add days to weeks for resolution.

Resubmission Window:

Correct and resubmit immediately to avoid duplicate fees.

Record Retention:

Vendors commonly retain A/V logs per state RON rules.

Agency Confirmation:

Confirm agency-specific deadlines before submission.

Key Milestones from Form Preparation to Results

Monitor these sequential stages so submitters can track progress and identify where delays commonly occur.

01

Form Completed

Applicant and requester verify all fields before capture.

02

Fingerprints Captured

Livescan vendor records prints and transmits to repository.

03

Repository Processing

Automated and manual checks compare prints with records.

04

Results Returned

Agency or requester receives the criminal-history response.

eSignature Pricing Comparison for Livescan Form Workflows

Compare vendor starting prices and core features relevant to Livescan form routing, HIPAA compliance, and bulk or volume submissions; signNow is listed first per vendor ordering rules.

signNow DocuSign Adobe Sign PandaDoc HelloSign
Starting Price $8/user/mo $15/user/mo $14/user/mo $19/user/mo $15/user/mo
Free Trial 7-day free trial Varies by plan Varies by plan Varies by plan Varies by plan
Bulk Send Yes Yes Yes Yes No
Audit Trail Yes Yes Yes Yes Yes
HIPAA Compliant Yes Yes Yes No No

Real-World Examples of Livescan Request Form Use

These short examples illustrate common scenarios where the Livescan Request Form prevents rework and improves processing.

University Hiring

A university requires faculty fingerprint checks for student-facing roles

  • The HR office collects signed forms and verifies ORI codes before scheduling livescan appointments
  • Proper form completion avoided re-submission, enabling onboarding to proceed without delay and maintaining compliance with institutional background-check policies.

Healthcare Credentialing

A hospital onboards a new nurse and requests criminal-history clearance

  • Licensing team provides the ORI and transaction reason to the vendor
  • The Livescan form captured accurate identifiers and consent, meeting HIPAA considerations and accelerating credentialing and access provisioning for clinical duties.

Frequently Asked Questions About the Livescan Request Form

Answers to common operational and legal questions about completing, submitting, and correcting Livescan Request Forms.


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