BCBA/BCaBA Opportunity to Respond Form - Behavior Analyst Certification Board

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 information outlined in the BACB Code–Enforcement Procedures document, you are entitled to due process. The BACB provides due process by sharing the Notice with you, giving you this opportunity 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; and
Must address the alleged violation(s) of BACB ethics requirements (i.e., The Professional and Ethical Compliance Code for Behavior Analysts ).

You have fifteen 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 reviews the details you provide in this form at a routing meeting and will make one of the following decisions:

Decline;
Place on 'Awaiting Third Party Determination' (ATPD);
Route for Educational review (if available to you); or
Route for Disciplinary review.

The BACB will contact you 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 and you will be unable to apply for certification for 5 years (you can find more information about the consequences for submitting falsified, forged, or untrue correspondences to the BACB here).

This is your only opportunity to respond to these allegations made against you. Failure to respond to this Notice will result in automatic suspension of your certification, application eligibility, and/or other status with the BACB, as outlined in section C3 of the BACB Code–Enforcement Procedures document.

Attestation*

I have read and understand the overview above.

Notice Details

Case ID (6-digit number found at the top of your Notice of Alleged Violation):*

Subject Name (Your Name):*

First Last

Select your current certification level with the BACB:*

BCaBA
BCBA/BCBA-D

Supervisor Name:*

First Last

Supervisor Credential #:*

If you do not currently have a supervisor of record, please enter “N/A” in the fields above.

Upload your Required Supervisor Acknowledgement Form here:*

Subject (Your) current and pending Certification/Licensure (State, Level, License #):*

Are you currently volunteering as a Subject Matter Expert in any capacity for the BACB?*

Yes
No

Are you currently an ACE provider or ACE Coordinator?*

Yes
No

Notifier Name (Name of person who submitted the Notice against you):*

If you were named in a Publicly Documented Notice of Alleged Violation, enter "unknown" for the Notifier first and last name.

First Last

Description and Evidence of Opportunity to Respond

You may submit supporting documentation as part of your Response. Your supporting documentation must not exceed 50 pages. 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 violations. 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.

Response to Allegation 1

In response to the allegation that I have violated the noted section of the Professional and Ethical Compliance Code, I select the following regarding this allegation. My explanation and evidence is as follows [800–character limit]:colon;

Code Section Alleged*

Response Type*

Response Description*

Please describe the file(s) that you are submitting as evidence to support your response to this alleged violation.*

Upload supporting documents*

Do you need to respond to a second allegation?*

Yes
No

Response to Allegation 2

In response to the allegation that I have violated the noted section of the Professional and Ethical Compliance Code, I select the following regarding this allegation. My explanation and evidence is as follows [800–character limit]:colon;

Code Section Alleged*

Response Type*

Response Description*

Please describe the file(s) that you are submitting as evidence to support your response to this alleged violation.*

Upload supporting documents*

Do you need to respond to a third allegation?*

Yes
No

Response to Allegation 3

In response to the allegation that I have violated the noted section of the Professional and Ethical Compliance Code, I select the following regarding this allegation. My explanation and evidence is as follows [800–character limit]:colon;

Code Section Alleged*

Response Type*

Response Description*

Please describe the file(s) that you are submitting as evidence to support your response to this alleged violation.*

Upload supporting documents*

Do you need to respond to a fourth allegation?*

Yes
No

Response to Allegation 4

In response to the allegation that I have violated the noted section of the Professional and Ethical Compliance Code, I select the following regarding this allegation. My explanation and evidence is as follows [800–character limit]:colon;

Code Section Alleged*

Response Type*

Response Description*

Please describe the file(s) that you are submitting as evidence to support your response to this alleged violation.*

Upload supporting documents*

Do you need to respond to a fifth allegation?*

Yes
No

Response to Allegation 5

In response to the allegation that I have violated the noted section of the Professional and Ethical Compliance Code, I select the following regarding this allegation. My explanation and evidence is as follows [800–character limit]:colon;

Code Section Alleged*

Response Type*

Response Description*

Please describe the file(s) that you are submitting as evidence to support your response to this alleged violation.*

Upload supporting documents*

Should you have need to respond to more than five allegations, please complete this form for the first five, submit, and then complete this form again, until you have addressed all allegations.

Sign & Submit

I confirm that this Response is truthful and complete to the best of my knowledge. 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.*

Yes, I confirm

Name*

First Last

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.

Date*