PSA incoming state contact information

Date Received

Enter the date on which you received the PSA information from the out-of-state agency. Use the format MM/DD/YYYY.

Date Processed

Enter the date on which you processed the PSA. Use the format MM/DD/YYYY.

Within three days, you must determine the need for contacting the originating state for any additional information and conduct a statewide records check in an attempt to locate the family. Each month thereafter, you continue conducting statewide records checks until the family is located or when the PSA is about to expire.

Other State Agency

Enter the name of the out-of-state agency. You can enter up to 150 characters.

Address

Enter the primary address of the out-of-state agency. You can enter up to 50 characters in each address field.

City

Enter the name of the city in which the agency is located. You can enter up to 50 characters.

State

Select the state in which the agency is located.

Zip

Enter the agency's zip code. Include the zip+four code in the second field if you have it.

Contact Person

Enter the full name of the person to be contacted at the out-of-state agency. You can enter up to 30 characters.

Telephone

Enter the contact person's 10-digit telephone number.

Fax

Enter the contact person's 10-digit fax number.

Email

Enter the contact person's email address. You can enter up to 50 characters.

Comments

Enter any additional information about the receipt of this PSA from the out-of-state agency. You can enter up to 1,000 characters.