Form LIC 508 O-O-S. Out-Of-State Disclosure

The LIC 508 O-O-S is a form that requires disclosure of out-of-state residence for the past five years. It is intended for licensees seeking approval to work, be present at or licensed facilities, certified family homes or home of a resource family. The purpose of this form is to facilitate a criminal background check by the Caregiver Background Check Bureau.

The form consists of instructions to licensees only and a privacy statement which explains that the use of social security number (SSN) is voluntary, but failure to provide it may delay the processing of the form and the criminal record check. The requested SSN is used as an identifying number by the California Department of Justice.

When filling out the form, the important field to consider is the disclosure of out-of-state residency in the last five years. Licensees must attach LIC 198B along with the form when disclosing out-of-state residency.

The parties involved are licensees seeking approval to work, be present at or licensed facilities, certified family homes or home of a resource family, and the Caregiver Background Check Bureau.

The form is important because it helps ensure the safety of the vulnerable populations served by the licensed facilities, certified family homes, and resource families. It also enables transparency and accountability by providing access to certain records containing personal information maintained by licensing or approval agencies.

A strength of this form is its ability to facilitate a criminal background check for licensees, ensuring a safe environment for vulnerable populations. A weakness is that it only applies to out-of-state residency within the past five years, potentially leaving gaps in a licensee's history. An opportunity is to expand the scope of the form to include all residences over a longer period. A threat is potential data breaches and misuse of personal information.

Examples of related forms include the LIC 198B and the Criminal Record Statement form. Analogues include similar forms used by other states' caregiver background check bureaus.

Submitting the form and accompanying documents is done by mail to the Caregiver Background Check Bureau in Sacramento, CA. The form and associated records are stored in a file created by the licensing or approval agency.

In conclusion, the LIC 508 O-O-S form is a crucial component of ensuring safe environments for vulnerable populations served by licensed facilities, certified family homes, and resource families. While there are limitations to the scope of the form, it serves as an important tool for transparency and accountability.