"Consent and Information Form for the National Missing Person Dna Database" - Connecticut

Consent and Information Form for the National Missing Person Dna Database is a legal document that was released by the Connecticut Department of Emergency Services and Public Protection - a government authority operating within Connecticut.

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CONSENT AND INFORMATION FORM
FOR THE NATIONAL MISSING PERSON DNA DATABASE
Missing Person Information
Missing Person's First Name
MI
Missing Person's Last Name
NCIC/NIC Number
Male or Female
NamUs Number
Donor Information
Sample Donor's First Name
MI
Sample Donor's Last Name
Kindred Relationship to Missing Person
STATEMENT OF CONSENT AND PRIVACY STATEMENT
I understand that the answers provided on this form are correct to the best of my knowledge and belief. I fully understand that my answers
are important to the evaluation of my kindred relationship to missing or unidentified persons.
Realizing that DNA may be extracted from my body fluid samples and used to assist in the identification of a kindred family member, I freely
agree to donate my body fluid(s) for DNA analysis and for that analysis to be included in the National Missing Person DNA Database,
maintained by the FBI under authority of Title 42, United States Code, Section 14132.
I freely and voluntarily consent to provide the CT Department of Emergency Services and Public Protection, Division of Scientific Services
with a blood and/or oral swab specimen(s) for DNA analysis and entry into the National Missing Person DNA Database. The DNA analysis
information will be released only to criminal justice agencies for identification and/or comparison to evidentiary items related to the
investigation of the disappearance of individuals indexed in the missing persons database. Additionally, supplemental information, including
the names and biological samples, will be retained by the CT Department of Emergency Services and Public Protection, Division of
Scientific Services separately from the missing persons database. Investigative agencies having online access to the missing persons
database may search the DNA analyses for DNA matches. If a match is found, the additional supplemental information may be released to
that agency in support of the purpose for which it was collected, as well as other lawful uses as provided by the Privacy Act notices for the
National DNA Index System.
I understand that I am not required or obligated to provide a DNA sample and my consent to have a DNA sample taken is
knowingly and voluntarily made.
Dated this ________________ day of ___________,
Signature of donor
Witnessed by
__________________________________________
____________________________________________
Law Enforcement Agency
Name of Law Enforcement Official Witnessing Collection (PRINT)
(__________)_________________________________________ Law
Enforcement Official Contact Phone number
CONSENT AND INFORMATION FORM
FOR THE NATIONAL MISSING PERSON DNA DATABASE
Missing Person Information
Missing Person's First Name
MI
Missing Person's Last Name
NCIC/NIC Number
Male or Female
NamUs Number
Donor Information
Sample Donor's First Name
MI
Sample Donor's Last Name
Kindred Relationship to Missing Person
STATEMENT OF CONSENT AND PRIVACY STATEMENT
I understand that the answers provided on this form are correct to the best of my knowledge and belief. I fully understand that my answers
are important to the evaluation of my kindred relationship to missing or unidentified persons.
Realizing that DNA may be extracted from my body fluid samples and used to assist in the identification of a kindred family member, I freely
agree to donate my body fluid(s) for DNA analysis and for that analysis to be included in the National Missing Person DNA Database,
maintained by the FBI under authority of Title 42, United States Code, Section 14132.
I freely and voluntarily consent to provide the CT Department of Emergency Services and Public Protection, Division of Scientific Services
with a blood and/or oral swab specimen(s) for DNA analysis and entry into the National Missing Person DNA Database. The DNA analysis
information will be released only to criminal justice agencies for identification and/or comparison to evidentiary items related to the
investigation of the disappearance of individuals indexed in the missing persons database. Additionally, supplemental information, including
the names and biological samples, will be retained by the CT Department of Emergency Services and Public Protection, Division of
Scientific Services separately from the missing persons database. Investigative agencies having online access to the missing persons
database may search the DNA analyses for DNA matches. If a match is found, the additional supplemental information may be released to
that agency in support of the purpose for which it was collected, as well as other lawful uses as provided by the Privacy Act notices for the
National DNA Index System.
I understand that I am not required or obligated to provide a DNA sample and my consent to have a DNA sample taken is
knowingly and voluntarily made.
Dated this ________________ day of ___________,
Signature of donor
Witnessed by
__________________________________________
____________________________________________
Law Enforcement Agency
Name of Law Enforcement Official Witnessing Collection (PRINT)
(__________)_________________________________________ Law
Enforcement Official Contact Phone number
KINDRED RELATIONSHIP
Please Circle your Kinship to the
Missing Person on the Family Tree Below
Grandmother
Grandfather
Grandfather
Aunt
Uncle
Mother
Father
Missing
Cousin
Sister
Brother
Spouse
Person
Niece
Nephew
Daughter
Son
Other
Explain Relationship:
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