FORM 9601bCS (07/13)
STATE OF NEW YORK DEPARTMENT OF CORRECTIONS AND COMMUNITY SUPERVISION

Post-Release Notice to Individuals Subject to Community Supervision Regarding Requests to Have Parental Contact with Biological/Adopted Minor Child(ren) When a Condition of Supervision Limiting or Prohibiting Contact is Contemplated or Has Been Imposed

Name:_________ DIN:_NYSID:_

Your release on community supervision is subject to certain conditions in order to increase your likelihood of being a law abiding member of the community. If you are the parent of a biological or adopted minor child and you have a special condition prohibiting or limiting contact with minors, and you wish to have contact with your child, you must make a request in writing to your Parole Officer for a determination regarding contact with your child.

Written requests for parental contact will be reviewed and determined eligible for further processing once the following materials have been satisfactorily submitted by you to your assigned Parole Officer:

1. a statement that a condition of supervision exists that prohibits or limits contact with your minor child; and

2. a statement that you desire to have contact with such child; and

3. documentary proof that you are the biological or adoptive parent of the child; and

4. a statement that the child is under the age of 18; and

5. a signed statement from the other parent or guardian of the child that supports contact between you and the child; and

6. a statement made under the penalty of perjury that you are not aware of any Order of Protection or other Court Order prohibiting or limiting the type or level of contact with the child you are seeking.

Once all materials are received and reviewed, an investigation will commence. You and the other parent/guardian of the child may be requested to sign release of information forms to assist in the investigation. Any special conditions limiting or prohibiting contact will apply while this investigation is pending.

You will be provided written notice of the Department’s decision.

If you wish to request contact with your child, please complete the attached form and submit it to your Parole Officer with all required documents.

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