Form LIC 401A is used in California to provide supplemental financial information for licensed facilities or programs. The main purpose of this form is to gather additional details about the financial status and resources of the licensee.
The form consists of sections where the licensee provides information related to their financial situation. This may include details about their assets, liabilities, income sources, expenses, and other relevant financial data. The form may also request supporting documentation or references to substantiate the financial information provided.