Form LIC 9163B. Request Live Scan Service - Long Term Care OMBUDSMAN - California

Form LIC 9163B is used in California to request Live Scan services for individuals involved with the Long Term Care Ombudsman program. This form is completed by individuals who require background checks as part of their roles within the Long Term Care Ombudsman program.

The form consists of sections that require the individual's personal information, demographics, and details about their association with the Long Term Care Ombudsman program. Important fields include the individual's full name, contact information, date of birth, Social Security number, and the reason for the Live Scan request. It is important to accurately provide all necessary information to facilitate the background check process and ensure compliance with program requirements.

An application example of this form would involve an individual completing Form LIC 9163B to request Live Scan services for their involvement in the Long Term Care Ombudsman program. They would provide their personal information, specify their association with the program, and state the reason for the Live Scan request. By successfully submitting this form and undergoing the required Live Scan process, the individual can demonstrate their eligibility and suitability for their role within the Long Term Care Ombudsman program.