Form LIC 9182. Criminal Background Clearance Transfer Request - California

The Criminal Background Clearance Transfer Request (Form LIC 9182) is used when an individual who already holds an active criminal record clearance in California needs to transfer that clearance from one licensed facility, organization, or home to another. This process helps avoid repeating fingerprinting and ensures that individuals may begin work or residence in a new licensed setting without unnecessary delays—provided the transfer is submitted before their first presence at the new location.

This form is commonly used across childcare facilities, adult care programs, residential care homes, foster family agencies, and other state-licensed environments where background clearances are legally required.

Purpose of the Form

Form LIC 9182 allows a licensee or applicant to transfer an already-approved criminal record clearance from one state-licensed facility to another. In California, many individuals—employees, administrators, adult residents, affiliated home care aides—are legally required to undergo background checks. Since individuals often change roles or locations within the care industry, this form enables them to move without restarting the entire clearance process.

The transfer must be filed before the individual enters the new facility. Failure to do so may result in a civil penalty of $100 per violation.

When the Form Is Required

• When an employee with an existing background clearance moves to a new licensed facility.
• When a facility administrator or licensee expands operations to an additional location.
• When an adult resident moves into a facility with licensing requirements.
• When a certified home under a Foster Family Agency (FFA) changes the associated agency.

When the Form Is Not Required

• When an individual does not have an active background clearance in the Licensing Information System.
• When the transfer is between county-licensed and state-licensed facilities (these require liaison coordination).
• When requesting an exemption transfer—this form does not cover exemptions.

Who May Complete the Form

• A facility licensee or administrator.
• A license applicant establishing a new facility.
• Directors or governing members (e.g., corporation board members, LLC partners) associated with the facility.

The licensee must verify the identity of the individual for whom the transfer is being requested.

Key Sections Explained

1. Individual Identification

This section collects essential identity details: full legal name, date of birth, driver’s license or state ID, and optional Social Security number. Errors here can cause delays because the Licensing Information System must match the existing clearance exactly.

2. “From” Facility Information

This identifies the facility where the clearance is currently active. Include the exact licensing number and full address. A common mistake is using informal facility names instead of the official name on record.

3. “To” Facility Information

This section must match the new facility’s state license record. The date of employment or association is important; it documents whether the transfer was submitted before the individual arrived—this affects compliance.

4. Association Type

Applicants must clearly identify their role (e.g., employee, administrator, spouse of licensee). Ambiguity in this field is a frequent reason transfers are paused by regional offices.

5. Out-of-State Disclosure (Children’s Residential Facilities Only)

If the individual lived outside California in the past five years, CDSS must perform an out-of-state child abuse registry check. This requirement stems from federal and state child safety regulations.

6. Privacy Notice

The form includes a mandatory Civil Code §1798.17 notice explaining how personal information is collected and used by the Department of Justice and the Care Provider Management Bureau.

Common Mistakes to Avoid

• Submitting the form after the individual has already entered the facility.
• Providing an incorrect facility license number.
• Missing dates in the Out-of-State Disclosure section.
• Failing to sign page 2—unsigned forms cannot be processed.
• Using a nickname or shortened name instead of the legal name on file.

Examples of Real Situations Where the Form Is Needed

• Childcare worker transferring centers: A teacher leaves a preschool in Los Angeles to join a new childcare center in Pasadena. Their clearance can be transferred instead of re-fingerprinted.
• Administrator opening a second facility: A residential care administrator licensed at one location opens a new facility. Their clearance must be formally associated with the new address.
• Adult resident moving into an RCFE: A non-client adult, such as a caregiver's spouse, moves into a senior care facility—they require clearance before residency.
• FFA certified home changing agencies: A foster family changes to a new Foster Family Agency and must transfer their clearances accordingly.

Required Documents

• Completed and signed LIC 9182.
• Government-issued photo ID for identity verification.
• LiveScan fingerprint receipt (only if a new CACI check is required).
• Out-of-state addresses (if applicable).

Practical Tips for Completing the Form

• Double-check all license numbers—incorrect numbers cause the most delays.
• Submit the form before the individual’s first day to avoid penalties.
• Ensure the “Association Type” box matches the person’s actual role.
• If unsure whether the individual has an active clearance, ask your regional office to verify.

FAQ

• Can I start work before the transfer is approved? No. The individual cannot be present in the facility until the transfer is processed.
• Do I need new fingerprints? Only if a required CACI check is missing or outdated.
• How long does the transfer usually take? Times vary, but transfers are typically faster than new background checks.
• Can I use this form for exemption transfers? No. Exemption transfers require separate procedures.
• Is the Social Security number required? No, it is optional, but it may assist with identity matching.

Micro-FAQ (Short Answers for Quick Reference)

• Purpose? Transfer an existing criminal record clearance.
• Who files? Licensees, administrators, or applicants.
• Submitted when? Before the individual enters the facility.
• Attachments? ID verification and out-of-state history if applicable.
• Submitted to? The California Department of Social Services.
• Fingerprints required? Only if no valid CACI check exists.
• Who needs it? Employees, administrators, adult residents, home care aides.
• Penalty for late submission? $100 civil penalty.

Related Forms

• LIC 508 – Criminal Record Statement
• LIC 9163 – Request for Live Scan Service
• LIC 813 – Verification of Administrator Qualifications
• LIC 9212 – Out-of-State Child Abuse Check Request

Form Details

• Name: Criminal Background Clearance Transfer Request
• Form Number: LIC 9182
• Issuing Agency: California Department of Social Services
• Region: State of California
• Latest Revision: 03/2023