CENTRALIZED CLEARANCE REQUESTS FOR ACCESS TO DOC FACILITIES
**You do NOT need this if you are family or friends visiting inmates**
***Reporters should NOT complete this form. ***
Instead, please contact the facility's public information officer
to obtain the appropriate News Media Relations form.
Any candidate, who is not an employee of the PA Department of Corrections (DOC), shall request Centralized Clearance access to a single DOC facility or multiple facilities by downloading and completing the Centralized Clearance Information Request Form.
Centralized Clearance Information Request Form
The candidate must specify the name of each facility that he/she anticipates traveling to during the clearance period. Clearance periods may be granted for a maximum of 12 months.
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. 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. Completed forms should not be scanned, emailed or faxed to an unsecured fax machine because they contain restricted/protected information, which should not be transmitted via a non-encrypted system.
The DOC contact representative/moderator, who is endorsing the candidate's clearance request, shall review the submitted form, then complete Section "B" . The COMMENTS field should identify the nature and/or the duration of an access period less than 12 months. The DOC representative/moderator will then confidentially forward this form (which should not be duplicated) to the facility Security Office.
The facility Security Office shall notify the endorsing Department representative/moderator of the clearance decision. All information shall be confidentially maintained in accordance with DOC policy and state regulations.
