Opportunity to Respond 1Intro2Counsel3Notice4Allegation5Allegation 26Allegation 37Allegation 48Allegation 59Signature The BACB directed you to this webpage because you have been named as a Subject in a Notice of Alleged Violation (Notice). As the Subject of this Notice, and in accordance with the BACB Code-Enforcement Procedures, you are entitled to due process. The BACB provides due process by sharing the Notice with you, allowing you to review the allegations submitted, and providing you with this opportunity to respond. Your response to the allegation(s) must: Be submitted in writing; Be submitted via this webpage; Address the alleged violation(s) of BACB ethics requirements (i.e., Ethics Code for Behavior Analysts, RBT Ethics Code (2.0)); AND Remove all identifying information about service recipient(s) (e.g., names, birth dates) from all documentation (if applicable). You have 15 days from the date the BACB emailed you a copy of the Notice and a link to this form to submit your response. The BACB will review the details you provide in this form and will make one of the following determinations: Decline; Close with a request for resubmission after 3rd party review(s) conclude; OR Issue an educational memorandum, proposed consent agreement, or disciplinary determination. The BACB will contact you via the email address in your BACB account to provide further information or any required actions. You are required to provide truthful responses to the BACB. If the BACB finds that your response to this Notice contains falsified, forged, or untrue information, your certification will be revoked. You will be unable to apply for certification for 5 years (review the Code-Enforcement Procedures for more information about the consequences for submitting falsified, forged, or untrue correspondences to the BACB). This is your only opportunity to respond to the allegation(s). Failure to respond will result in the Notice being processed without your input. The review committee may consider your failure to respond as a factor in their decision.Response Agreement(Required) I have reviewed and agree to the overview above.Code-Enforcement Procedures(Required)Please review the Code-Enforcement Procedures, located on the Ethics Codes web page Checking this means you recognize the existence of this Ethics resource and agree to any terms stated within. Further, you authorize the BACB to process your response in accordance with the processing requirements stated within. I agree to comply with the BACB’s processing requirements and authorize the BACB to process this Notice per the Code-Enforcement Procedures. Representation of Counsel You are not required to retain counsel to represent you as part of the processing of this case; however, you may elect to be represented by an attorney. Note: if you retain counsel, all correspondence regarding this case will go directly to your attorney. Any correspondence with you directly will cease, and you will be directed to consult with your attorney.Are you represented by counsel in this BACB Ethics matter?(Required) Yes No Attorney Full Name(Required) First Last Attorney Phone Number(Required)Attorney Website Attorney Email Address(Required) Notice Case ID(Required)Please include the Subject's (your) full name, as listed on the BACB Certificant Registry(Required)Review the BACB Certificant Registry to verify certification status and view up-to-date information on certificants. First Last Please include the Subject's (your) email address(Required)Use the email address associated with your BACB account. The BACB will only communicate with you using the email address on file. If you no longer have access to this email address, please update it in your BACB account. What is your highest level of certification?(Required) RBT certificant/applicant BCaBA certificant/applicant BCBA certificant/applicant Have you shared the Notice with your supervisor?(Required)As required in code standard 3.06 of the RBT Ethics Code (2.0), you are required to share a copy of the Notice naming you with your supervisor(s). Yes No N/A I do not have a supervisor Supervisor's Full Name(Required)Please use the name your supervisor has listed on the BACB Certificant Registry. First Last Supervisor's Certification Number(Required)Please use the number your supervisor has listed on the BACB Certificant Registry.Your Current and Pending Certification/LicensureIf not applicable, leave blank. Please use the green and red buttons to the right of each location to add or remove additional rows. If not applicable, leave blank.StateLevelCertification / License # Add RemoveAre you currently volunteering as a Subject Matter Expert in any capacity for the BACB?(Required) Yes No For which department are you volunteering?(Required)Certification ServicesEthicsTestingAre you currently an ACE Provider or ACE Coordinator?(Required) Yes No Please include the Notifier's full name(Required)If you were named in a Publicly Documented Notice of Alleged Violation, enter "unknown” for the Notifier’s first and last names. First Last Initial AllegationYou can address multiple allegations in your response. This section is for the initial allegation only, and the information and supporting documentation provided should be unique to the initial allegation. You will have the opportunity to provide information and documentation specific to each allegation later. For documentation supporting multiple allegations, upload it with the first applicable allegation only.Response to Allegation In response to the allegation that I have violated the noted section of the Ethics Code for Behavior Analysts/RBT Ethics Code (2.0), I select the following regarding this allegation. My explanation and evidence is as follows:[1] Code Section Alleged(Required)[1] Response Type(Required)Please select oneAdmitDenyPartially admit / Partially DenyInitial Allegation Statement and Supporting DocumentationYou may submit supporting documentation as part of your Response. Your supporting documentation must not exceed 50 pages total (for addressing all allegations). Please upload a statement that describes your response to the allegation alleged. It is highly recommended that you organize your Response and supporting documentation with: Page numbers; A table of contents; Clear references connecting the supporting documentation to the specific allegation(s) to which it relates; and Submitted documentation must be pertinent and relevant to the alleged violation(s). Your submitted documentation must be compliant with HIPAA and/or FERPA regulations regarding protection of client files and privacy. The BACB will not accept improperly or insufficiently redacted documentation. The uploaded statement is included in your 50 page limit.[1] Response statement(Required) [1A] Affidavit of witness statement(s) [1A] Number of Pages(Required)[1A] Relevance(Required)[1B] Email/text message records or other correspondence (e.g., meeting notes, interview transcripts) [1B] Number of Pages(Required)[1B] Relevance(Required)[1C] Website screenshots [1C] Number of Pages(Required)[1C] Relevance(Required)[1D] Documentation of performance feedback [1D] Number of Pages(Required)[1D] Relevance(Required)[1E] Video/audio [1E] Relevance and Access Information(Required)Please describe the relevance of the video/audio below. A BACB staff member will respond via email with a secure link where you can upload video/audio files.[1F] Court or legal documents [1F] Number of Pages(Required)[1F] Relevance(Required)[1G] Misused or forged documents [1G] Number of Pages(Required)[1G] Relevance(Required)[1H] Third-Party determination [1H] Number of Pages(Required)[1H] Relevance(Required)[1I] Billing records (e.g., repayment plan, audit findings, investigation results) [1I] Number of Pages(Required)[1I] Relevance(Required)[1J] Behavior Plans/Assessment [1J] Number of Pages(Required)[1J] Relevance(Required)[1K] Proof of training (e.g., crisis intervention, billing appropriately) [1K] Number of Pages(Required)[1K] Relevance(Required)[1L] None of the above [1L] Please describe the type of documentation.(Required)[1L] Number of Pages(Required)[1L] Relevance(Required) ISSUE: The option you have selected prevents you from proceeding further. Every response to an allegation must have have recorded documentation, and the BACB requires context and relevance for that documentation. Before you can proceed, please make sure to specify the kind of documentation above, along with the supplemental information related to it. [1M] Please upload all supporting documentation(Required)This field only allows 11 files: one for the response statement and one for each specific supporting documentation type (excluding videos and audio). To meet this limit, consolidate all documentation elements into individual, multi-page files. Ensure this documentation is unique to this response. You can provide additional documentation later if addressing other alleged violations in this Notice. For information on consolidating and combining PDFs, please review this Adobe resource. Drop files here or Select files Max. file size: 10 MB, Max. files: 11. Do you have a second allegation to address?(Required) Yes No Second AllegationThis specific section is for the second allegation only. The following information and supporting documentation should be unique to the allegation. You will have the opportunity to provide information and documentation specific to each allegation. If you have documentation that refutes multiple allegations provided in this response, you only need to upload this documentation once. Please upload them with the first applicable allegation.Response to Allegation In response to the allegation that I have violated the noted section of the Ethics Code for Behavior Analysts/RBT Ethics Code (2.0), I select the following regarding this allegation. My explanation and evidence is as follows:[2] Code Section Alleged(Required)[2] Response Type(Required)Please select oneAdmitDenyPartially admit / Partially DenySecond Response to Allegation and Supporting DocumentationYou may submit supporting documentation as part of your Response. Your supporting documentation must not exceed 50 pages total (for addressing all allegations). Please upload a statement that describes your response to the allegation alleged. It is highly recommended that you organize your Response and supporting documentation with: Page numbers; A table of contents; Clear references connecting the supporting documentation to the specific allegation(s) to which it relates; and Submitted documentation must be pertinent and relevant to the alleged violation(s). Your submitted documentation must be compliant with HIPAA and/or FERPA regulations regarding protection of client files and privacy. The BACB will not accept improperly or insufficiently redacted documentation. The uploaded statement is included in your 50 page limit.[2] Response statement(Required) [2A] Affidavit of witness statement(s) [2A] Number of Pages(Required)[2A] Relevance(Required)[2B] Email/text message records or other correspondence (e.g., meeting notes, interview transcripts) [2B] Number of Pages(Required)[2B] Relevance(Required)[2C] Website screenshots [2C] Number of Pages(Required)[2C] Relevance(Required)[2D] Documentation of performance feedback [2D] Number of Pages(Required)[2D] Relevance(Required)[2E] Video/audio [2E] Relevance and Access Information(Required)Please describe the relevance of the video/audio below. A BACB staff member will respond via email with a secure link where you can upload video/audio files.[2F] Court or legal documents [2F] Number of Pages(Required)[2F] Relevance(Required)[2G] Misused or forged documents [2G] Number of Pages(Required)[2G] Relevance(Required)[2H] Third-Party determination [2H] Number of Pages(Required)[2H] Relevance(Required)[2I] Billing records (e.g., repayment plan, audit findings, investigation results) [2I] Number of Pages(Required)[2I] Relevance(Required)[2J] Behavior Plans/Assessment [2J] Number of Pages(Required)[2J] Relevance(Required)[2K] Proof of training (e.g., crisis intervention, billing appropriately) [2K] Number of Pages(Required)[2J] Relevance(Required)[2L] None of the above [2L] Please describe the type of documentation.(Required)[2L] Number of Pages(Required)[2L] Relevance(Required)[2M] Please upload all supporting documentation(Required)This field only allows 11 files: one for the response statement and one for each specific supporting documentation type (excluding videos and audio). To meet this limit, consolidate all documentation elements into individual, multi-page files. Ensure this documentation is unique to this response. You can provide additional documentation later if addressing other alleged violations in this Notice. For information on consolidating and combining PDFs, please review this Adobe resource. Drop files here or Select files Max. file size: 10 MB, Max. files: 11. Do you have a third allegation to address?(Required) Yes No Third AllegationThis specific section is for the third allegation only. The following information and supporting documentation should be unique to the allegation. You will have the opportunity to provide information and documentation specific to each allegation. If you have documentation that refutes multiple allegations provided in this response, you only need to upload this documentation once. Please upload them with the first applicable allegation.Response to Allegation In response to the allegation that I have violated the noted section of the Ethics Code for Behavior Analysts/RBT Ethics Code (2.0), I select the following regarding this allegation. My explanation and evidence is as follows:[3] Code Section Alleged(Required)[3] Response Type(Required)Please select oneAdmitDenyPartially admit / Partially DenyThird Response to Allegation and Supporting DocumentationYou may submit supporting documentation as part of your Response. Your supporting documentation must not exceed 50 pages total (for addressing all allegations). Please upload a statement that describes your response to the allegation alleged. It is highly recommended that you organize your Response and supporting documentation with: Page numbers; A table of contents; Clear references connecting the supporting documentation to the specific allegation(s) to which it relates; and Submitted documentation must be pertinent and relevant to the alleged violation(s). Your submitted documentation must be compliant with HIPAA and/or FERPA regulations regarding protection of client files and privacy. The BACB will not accept improperly or insufficiently redacted documentation. The uploaded statement is included in your 50 page limit.[3] Response statement(Required) [3A] Affidavit of witness statement(s) [3A] Number of Pages(Required)[3A] Relevance(Required)[3B] Email/text message records or other correspondence (e.g., meeting notes, interview transcripts) [3B] Number of Pages(Required)[3B] Relevance(Required)[3C] Website screenshots [3C] Number of Pages(Required)[3C] Relevance(Required)[3D] Documentation of performance feedback [3D] Number of Pages(Required)[3D] Relevance(Required)[3E] Video/audio [3E] Relevance and Access Information(Required)Please describe the relevance of the video/audio below. A BACB staff member will respond via email with a secure link where you can upload video/audio files.[3F] Court or legal documents [3F] Number of Pages(Required)[3F] Relevance(Required)[3G] Misused or forged documents [3G] Number of Pages(Required)[3G] Relevance(Required)[3H] Third-Party determination [3H] Number of Pages(Required)[3H] Relevance(Required)[3I] Billing records (e.g., repayment plan, audit findings, investigation results) [3I] Number of Pages(Required)[3I] Relevance(Required)[3J] Behavior Plans/Assessment [3J] Number of Pages(Required)[3J] Relevance(Required)[3K] Proof of training (e.g., crisis intervention, billing appropriately) [3K] Number of Pages(Required)[3K] Relevance(Required)[3L] None of the above [3L] Please describe the type of documentation.(Required)[3L] Number of Pages(Required)[3L] Relevance(Required)[3M] Please upload all supporting documentation(Required)This field only allows 11 files: one for the response statement and one for each specific supporting documentation type (excluding videos and audio). To meet this limit, consolidate all documentation elements into individual, multi-page files. Ensure this documentation is unique to this response. You can provide additional documentation later if addressing other alleged violations in this Notice. For information on consolidating and combining PDFs, please review this Adobe resource. Drop files here or Select files Max. file size: 10 MB, Max. files: 11. Do you have a fourth allegation to address?(Required) Yes No Fourth Response to Allegation and Supporting DocumentationThis specific section is for the fourth allegation only. The following information and supporting documentation should be unique to the allegation. You will have the opportunity to provide information and documentation specific to each allegation. If you have documentation that refutes multiple allegations provided in this response, you only need to upload this documentation once. Please upload them with the first applicable allegation.Response to Allegation In response to the allegation that I have violated the noted section of the Ethics Code for Behavior Analysts/RBT Ethics Code (2.0), I select the following regarding this allegation. My explanation and evidence is as follows:[4] Code Section Alleged(Required)[4] Response Type(Required)Please select oneAdmitDenyPartially admit / Partially DenyFourth Allegation Statement and Supporting DocumentationYou may submit supporting documentation as part of your Response. Your supporting documentation must not exceed 50 pages total (for addressing all allegations). Please upload a statement that describes your response to the allegation alleged. It is highly recommended that you organize your Response and supporting documentation with: Page numbers; A table of contents; Clear references connecting the supporting documentation to the specific allegation(s) to which it relates; and Submitted documentation must be pertinent and relevant to the alleged violation(s). Your submitted documentation must be compliant with HIPAA and/or FERPA regulations regarding protection of client files and privacy. The BACB will not accept improperly or insufficiently redacted documentation. The uploaded statement is included in your 50 page limit.[4] Response statement(Required) [4A] Affidavit of witness statement(s) [4A] Number of Pages[4A] Relevance(Required)[4B] Email/text message records or other correspondence (e.g., meeting notes, interview transcripts) [4B] Number of Pages(Required)[4B] Relevance(Required)[4C] Website screenshots [4C] Number of Pages(Required)[4C] Relevance(Required)[4D] Documentation of performance feedback [4D] Number of Pages(Required)[4D] Relevance(Required)[4E] Video/audio [4E] Relevance and Access Information(Required)Please describe the relevance of the video/audio below. A BACB staff member will respond via email with a secure link where you can upload video/audio files.[4F] Court or legal documents [4F] Number of Pages(Required)[4F] Relevance(Required)[4G] Misused or forged documents [4G] Number of Pages(Required)[4G] Relevance(Required)[4H] Third-Party determination [4H] Number of Pages(Required)[4H] Relevance(Required)[4I] Billing records (e.g., repayment plan, audit findings, investigation results) [4I] Number of Pages(Required)[4I] Relevance(Required)[4J] Behavior Plans/Assessment [4J] Number of Pages(Required)[4J] Relevance(Required)[4K] Proof of training (e.g., crisis intervention, billing appropriately) [4K] Number of Pages(Required)[4K] Relevance(Required)[4L] None of the above [4L] Please describe the type of documentation.(Required)[4L] Number of Pages(Required)[4L] Relevance(Required)[4M] Please upload all supporting documentation(Required)This field only allows 11 files: one for the response statement and one for each specific supporting documentation type (excluding videos and audio). To meet this limit, consolidate all documentation elements into individual, multi-page files. Ensure this documentation is unique to this response. You can provide additional documentation later if addressing other alleged violations in this Notice. For information on consolidating and combining PDFs, please review this Adobe resource. Drop files here or Select files Max. file size: 10 MB, Max. files: 11. Do you have a fifth allegation to address?(Required) Yes No Fifth Response to Allegation and Supporting DocumentationThis specific section is for the fifth and final allegation only. The following information and supporting documentation should be unique to the allegation. You will have the opportunity to provide information and documentation specific to each allegation. If you have documentation that refutes multiple allegations provided in this response, you only need to upload this documentation once. Please upload them with the first applicable allegation.Response to Allegation In response to the allegation that I have violated the noted section of the Ethics Code for Behavior Analysts/RBT Ethics Code (2.0), I select the following regarding this allegation. My explanation and evidence is as follows:[5] Code Section Alleged(Required)[5] Response Type(Required)Please select oneAdmitDenyPartially admit / Partially DenyFifth Allegation Statement and Supporting DocumentationYou may submit supporting documentation as part of your Response. Your supporting documentation must not exceed 50 pages total (for addressing all allegations). Please upload a statement that describes your response to the allegation alleged. It is highly recommended that you organize your Response and supporting documentation with: Page numbers; A table of contents; Clear references connecting the supporting documentation to the specific allegation(s) to which it relates; and Submitted documentation must be pertinent and relevant to the alleged violation(s). Your submitted documentation must be compliant with HIPAA and/or FERPA regulations regarding protection of client files and privacy. The BACB will not accept improperly or insufficiently redacted documentation. The uploaded statement is included in your 50 page limit.[5] Response statement(Required) [5A] Affidavit of witness statement(s) [5A] Number of Pages(Required)[5A] Relevance(Required)[5B] Email/text message records or other correspondence (e.g., meeting notes, interview transcripts) [5B] Number of Pages(Required)[5B] Relevance(Required)[5C] Website screenshots [5C] Number of Pages(Required)[5C] Relevance(Required)[5D] Documentation of performance feedback [5D] Number of Pages(Required)[5D] Relevance(Required)[5E] Video/audio [5E] Relevance and Access Information(Required)Please describe the relevance of the video/audio below. A BACB staff member will respond via email with a secure link where you can upload video/audio files.[5F] Court or legal documents [5F] Number of Pages(Required)[5F] Relevance(Required)[5G] Misused or forged documents [5G] Number of Pages(Required)[5G] Relevance(Required)[5H] Third-Party determination [5H] Number of Pages(Required)[5H] Relevance(Required)[5I] Billing records (e.g., repayment plan, audit findings, investigation results) [5I] Number of Pages(Required)[5I] Relevance(Required)[5J] Behavior Plans/Assessment [5J] Number of Pages(Required)[5J] Relevance(Required)[5K] Proof of training (e.g., crisis intervention, billing appropriately) [5K] Number of Pages(Required)[5K] Relevance(Required)[5L] None of the above [5L] Please describe the type of documentation.(Required)[5L] Number of Pages(Required)[5L] Relevance(Required)[5M] Please upload all supporting documentation(Required)This field only allows 11 files: one for the response statement and one for each specific supporting documentation type (excluding videos and audio). To meet this limit, consolidate all documentation elements into individual, multi-page files. Ensure this documentation is unique to this response. You can provide additional documentation later if addressing other alleged violations in this Notice. For information on consolidating and combining PDFs, please review this Adobe resource. Drop files here or Select files Max. file size: 10 MB, Max. files: 11. Terms & Agreements By signing and submitting this response, I agree to comply with the Terms of Use and I confirm that this Response is truthful and complete to the best of my knowledge. Further, I confirm that I have complied with the BACB’s requirements for submission of a Response, specifically regarding format, page limits, and relevance of content. Signature First Last Attestation I attest that I am the signer in this agreement and that the information provided herein is true and accurate to the best of my ability. This agreement may be executed by the electronically transmitted signature (typed name in signature field), and such signature shall be deemed as valid as an original signature
