Welcome to the
Congregate Care Payment Issues (CCPI) Request Form

DCS Disclaimer

Department of Child Safety (DCS) records and files are confidential and protected by A.R.S. ยง 8-807, ยง 8-807.01 and ยง 41-1959, which require DCS to protect its records and data from unauthorized access and misuse while maintaining security and confidentiality.

I am aware that various laws and rules, as well as policies and procedures of DCS, govern the confidentiality of DCS information and I agree to abide by all such applicable laws, rules, policies and procedures. I agree that I may not copy, print, or re-disseminate DCS information in any form other than that required to meet my obligations.

I understand that I do not have the right now nor am I authorized to disclose or reveal or use in any way for my own purpose or the purpose of any third parties any confidential DCS information that I have obtained or had access to.

I understand that if I violate the laws, rules, policies or procedures regarding the use or disclosure of confidential DCS information, I may be charged with a class 2 misdemeanor pursuant to A.R.S. ยง 8-807 (W). I understand that I am responsible for reporting to DCS any unauthorized disclosure of confidential information that I may become aware of.

Only proceed if using for offical business as part of a CCPI Request

Select from one of the folowing options:
Start Request Back to AZDCS

Be Advised

This application will time out after 10 minutes of inactivity, ensure to have all documents ready prior to starting the application process.


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U-Form Version: 80.0 - 11/2024