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Background Study Log (Name of Licensed Provider or Home Name) # Name Date Sent to County Date Clearance Received 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. Minnesota Statute 245C.20 requires that a provider contact their licensor about the status of the background check if they have not received a response within 45 days of submission. CCSS (03-2010)