Form LIC 200. Application For A Community Care Facility or Residential Care Facility For The Elderly License - California

Form LIC 200 is an application form used in California to apply for a license to operate a Community Care Facility or Residential Care Facility for the Elderly. Its main purpose is to collect detailed information about the applicant and the facility to determine eligibility for licensure.

The form consists of sections where the applicant provides personal information, such as name, address, and contact details. It also gathers details about the proposed facility, including its location, capacity, services provided, and staffing plans. Additionally, the form may require information related to background checks, finances, and compliance with regulations.

Important fields on this form include accurate and comprehensive information about the applicant and the proposed facility. It is crucial to provide all required documentation, including supporting materials such as floor plans, financial statements, and personnel records, to demonstrate compliance with licensing standards.

Application Example: When seeking a license to operate a Community Care Facility or Residential Care Facility for the Elderly in California, an applicant must complete Form LIC 200. By carefully filling out the application and submitting all necessary documents, the applicant can demonstrate their qualifications and readiness to provide quality care to elderly individuals.

Related Forms: Form LIC 809, Notice of Site Visit Findings, is a related form used during the inspection process to document findings and compliance with regulations. Form LIC 200 focuses on the initial application for licensure, while Form LIC 809 provides feedback based on site visits and evaluations.