Form LIC 9165 is used in California for individuals seeking approval as board members for licensed facilities regulated by the California Department of Social Services. This form is completed by individuals who wish to serve as board members and provide a statement of their qualifications and commitment.
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.
Form LIC 9163 is used in California to request Live Scan services for individuals associated with Community Care Licensing. This form is completed by individuals who require background checks as part of their involvement in Community Care Licensing programs.
Form LIC 9142A is used to create a roster of participants for courses approved under the Administrator Certification Program in California. This form is completed by course providers to document the attendance and completion of approved courses by participants.
Form LIC 9141 is used for the application or renewal of vendor status in California's Administrator Certification Program. This form is completed by vendors who provide goods or services to individuals seeking administrator certification in facilities regulated by the California Department of Social Services.
Form LIC 9140A is used in California to request the addition or replacement of an instructor in a course approved under the Administrator Certification Program. This form is completed by course providers who need to add a new instructor or replace an existing instructor for their approved course.
Form LIC 9140 is used to request course approval in the Administrator Certification Program in California. This form is completed by course providers who intend to offer new educational courses for administrators in facilities regulated by the California Department of Social Services.
Form LIC 9139 is used for the renewal of Continuing Education Course Approval in the Administrator Certification Program in California. This form is completed by course providers who offer continuing education courses for administrators in facilities regulated by the California Department of Social Services.
Form LIC 9128 is a Foster Family Agency Program Statement used in California. This form is utilized by foster family agencies to provide detailed information about their programs, services, and policies to the California Department of Social Services.
Form LIC 9123 is a Facility Inspection Checklist designed specifically for Residential Care Facilities for the Elderly (RCFE) in California. This checklist is used by representatives from the California Department of Social Services during inspections to evaluate the compliance of RCFEs with state regulations and licensing requirements.
