Forms and documents
LIC 01A - Resource Family Application
Form LIC 01A is the primary application form for individuals or families interested in becoming resource families.
LIC 00A - Conversion - Resource Family Application
Form LIC 00A is an application form used during the process of converting a foster care home or licensed facility into a resource family.
LIC 00 - Conversion to Resource Family: Release of Information
Form LIC 00 is used when converting a foster care home or another type of licensed facility to a resource family. It is a Release of Information form that enables the disclosure and sharing of necessary information between the relevant parties involved in the conversion process.
LIC 403A - Balance Sheet Supplemental Schedule
Form LIC 403A is a supplemental schedule used in conjunction with the Balance Sheet (LIC 403) for licensed facilities in California. The form provides additional details, explanations, or breakdowns of specific balance sheet components, such as assets, liabilities, and equity.
ICPC 100A Instructions Instructions For Completing Form ICPC 100A Interstate Compact On The Placement Of Children Request
These instructions provide guidance on how to complete Form ICPC-100A, which is used for requesting the Interstate Compact on the Placement of Children (ICPC).
LIC 501 - CCL/Personnel Record
Form LIC 501 is a record used to document and maintain personnel information for Community Care Licensing (CCL) purposes in licensed facilities in California.
LIC 500 - Personnel Report
Form LIC 500 is a personnel report used by licensed facilities in California to provide information about their employees or staff members.
LIC 421IM - Civil Penalty Assessment Immediate $500 And Repeat Violations
Form LIC 421IM is a civil penalty assessment form used by the California Department of Social Services (CDSS) to address immediate and repeat violations in licensed facilities.
LIC 421FC - Civil Penalty Assessment Failure To Correct And Repeat Violations
Form LIC 421FC is a civil penalty assessment form used by the California Department of Social Services (CDSS) to address repeated violations and failure to correct deficiencies in licensed facilities.
LIC 421D - Civil Penalty Assessment Death/Serious Bodily Injury/Physical Abuse
The LIC 421D form is specifically designed by the California Department of Social Services for assessing civil penalties in cases involving death, serious bodily injury, or physical abuse.