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SUSPECTED CHILD ABUSE REPORT To Be Completed by Mandated Child Abuse Reporters Pursuant to Penal Code Section 11166CASE NAME:PLEASE PRINT OR TYPE NAME OF MANDATED REPORTERNAME0aiStreet@,for 0 an Address
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DSS-2221A is the form used by the Office of [insert specific office] to report [insert specific information].
All entities or individuals designated by the Office of [insert specific office] are required to file the DSS-2221A form.
To fill out the DSS-2221A form, one must provide accurate and detailed information as requested by the Office of [insert specific office].
The purpose of DSS-2221A is to collect specific data or information required by the Office of [insert specific office] for [insert purpose].
The DSS-2221A form requires reporting of [insert specific information] in order to comply with the regulations set by the Office of [insert specific office].
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