Form LIC 856A. Complaint Intake Notification - California

Form LIC 856A is used in California by the Department of Social Services to notify individuals or entities about the receipt and intake of a complaint. The main purpose of this form is to inform the complainant and relevant parties that their complaint has been received and will be reviewed by the department.

The form consists of sections where the department provides information about the complaint, such as the complainant's name and contact information, the nature of the complaint, and any additional details available at the time of intake. It may also include reference numbers or tracking information related to the complaint.

Important fields on this form include accurately recording the details of the complaint, providing clear information about the intake process, and including appropriate contact information for the department. It is essential for the department to promptly send this form to complainants to acknowledge their complaint and keep them informed about the process.

Application Example: An individual files a complaint against a licensed facility in California regarding alleged violations of regulations. The Department of Social Services sends Form LIC 856A to the complainant, acknowledging the receipt of the complaint and providing initial information about the intake process. This form helps establish communication between the department and the complainant, ensuring transparency and responsiveness in addressing the concerns raised.