Social Security

The Emergency Disaster Plan for Adult Day Programs, Adult Residential Facilities, Residential Care Facilities for the Chronically Ill and Social Rehabilitation Facilities is a form provided by the California Department of Social Services. The main purpose of the form is to ensure that the licensee has an emergency disaster plan in place in case of any unforeseen natural disasters or emergencies.

LIC 605A is a form used to release client/resident medical information by the California Department of Social Services, Community Care Licensing. The primary purpose of this form is to obtain consent from the client or their authorized representative to release their medical information to specified individuals or entities.

Form LIC 601 is a mandatory document required by the California Department of Social Services, Health and Human Services Agency's Community Care Licensing Division. The primary purpose of this form is to gather identification and emergency information on every person admitted to a community care facility in California.

Form LIC 215 is a crucial form used by the California Department of Social Services' Community Care Licensing Division to collect applicant information for various social services programs in California.

The main purpose of this form is to gather personal and financial information about individuals who are seeking social services benefits such as CalWORKs, Medi-Cal, and CalFresh. The form consists of several sections covering different aspects of the applicant's background, including personal details, household members, income and expenses, assets and debts, and medical expenses.

Form LIC 125 is a mandatory checklist required by the California Department of Social Services, Health and Human Services Agency for child care centers. The primary purpose of this form is to ensure that all necessary requirements are met before admitting a child to a licensed child care center.

LIC 610A is a form used for creating an Emergency Disaster Plan for Family Child Care Homes. The main purpose of the form is to ensure the safety and well-being of children in family child care homes during emergency situations such as natural disasters, fires, or other unforeseen events.

LIC 999A is a Facility Sketch or Floor Plan form intended for use by individuals who want to operate a Family Child Care Home. The purpose of this form is to provide a detailed plan of the facility to the relevant licensing agency for approval. This form consists of several fields that require detailed information about the layout and dimensions of the home, including the number and size of rooms, exits, and outdoor play areas.

The LIC 627C Consent for Emergency Medical Treatment Form is a vital document required by Adult and Elderly Residential Facilities in certain situations. The purpose of this form is to obtain the consent of an individual or their authorized representative for emergency medical treatment if the need arises, and they are unable to provide informed consent at the time.

The LIC 9172 form is a Functional Capability Assessment required by Adult Residential and Social Rehabilitation Facilities, Adult Day Care Facilities, and Adult Day Support Centers. The goal of the form is to obtain information on an applicant's functional ability prior to placement in order to create a Needs and Services Plan for that individual.

The LIC 200A form is an application for a Child Care Center License in California. The purpose of the form is to provide information about the applicant(s), facility/agency, and the type of child care services being provided. The form consists of 20 fields that need to be completed accurately.