Information received from this form will be transmitted to the appropriate state agency in satisfaction of reporting requirements under Chapter 775 of the Health and Safety Code. This form is for the report required for January 1, 2024. If you wish to submit a report for a different year, contact SAFE-D at email@example.com.
Please familiarilze yourself with the form before you begin submitting answers, because there is no mechanism to save the form and return later.
Note: If there is a vacancy in a commissioner's spot, use "NA" in fields and "firstname.lastname@example.org" for the email address.