Criminal History Form

Please print all nine (9) pages of form and complete as directed for all family members 18 years and older who are listed on the Pre-Application form.

Your completion of this form must be Printed Legibly. Your Full Name and Date of Birth must be the same as on your current Goverment ID or Drivers License. Your Social Security Number must be the same as on your social security card.

Upon completion of the form(s), you have the following options to return it to OHA.

• Fax 402-546-3604 Attention Intake
• Hand deliver or mail to OHA, Attention Intake, 4401 North 21st Street, Omaha NE 68110
• E-mail (non-secure) to  This e-mail address is being protected from spambots. You need JavaScript enabled to view it  

Criminal history form(s) should be submitted within five (5) days of submission of the Pre-Application form. Processsing cannot begin until both the Pre-Application form and Criminal History forms are received. 

                                                                                                      Criminal History Form