California Department of Social Services

Form LIC 9217 is a readiness guide designed for individuals planning to open a family child care home in California. The form provides detailed information and guidance on the steps involved in establishing a licensed family child care business. It covers areas such as facility preparation, health and safety requirements, program policies, record-keeping practices, staffing considerations, and interactions with licensing agencies.

Form LIC 9020A is specifically designed for residential care facilities for the elderly (RCFE) in California to maintain a register of facility residents. The form is completed by RCFE staff and includes details such as the resident's name, date of admission, date of discharge if applicable, identification numbers, and other pertinent information.

By utilizing this form, RCFEs ensure accurate record-keeping, monitor occupancy levels, comply with licensing regulations, and have essential information readily available for administrative and care purposes.

Form LIC 503 is a health screening report used for facility personnel in licensed facilities in California. The form is completed by the individual undergoing the health screening and includes information about their medical history, immunization records, current health status, and any communicable diseases.

By utilizing this form, facility operators ensure that personnel meet health requirements, promote a safe working environment, and reduce the risk of infectious diseases within the facility.

The LIC 9239 YHPC form serves as an entrance checklist specifically tailored for Youth Homelessness Prevention Centers (YHPCs) within the California Department of Social Services. This checklist is used during the admission process for youth who are at risk of homelessness or experiencing housing instability. It ensures that all necessary procedures and criteria are followed to provide immediate support and intervention. The checklist covers areas such as intake assessments, crisis intervention plans, safety protocols, consent forms, and initial orientation.

The LIC 9266 Form 5-2 is used to report and document long-term debt that was incurred during the fiscal year by facilities regulated by the California Department of Social Services. This form captures information such as the purpose of the debt, the borrowing entity, the principal amount, interest rates, repayment terms, and any related financial agreements or contracts. It ensures accurate tracking and disclosure of newly incurred long-term debts, providing transparency and accountability in financial reporting.

The LIC 9267 Form 5-3 is used to calculate the long-term debt reserve amount for facilities regulated by the California Department of Social Services. This form considers factors such as the outstanding long-term debt, interest rates, and repayment terms to determine the appropriate reserve amount that needs to be set aside to meet future debt service obligations. It ensures that facilities maintain adequate reserves to fulfill their financial responsibilities, promoting financial stability and sustainability.

The LIC 9268 Form 5-4 is used to calculate the net operating expenses for facilities regulated by the California Department of Social Services. This form considers income, expenses, and other financial factors to determine the net operating expenses, which represent the difference between total income and total expenses. It helps facility operators assess their financial performance and viability, identifying areas for improvement and ensuring sound fiscal management.

The LIC 9269 Form 5-5 is used by facilities regulated by the California Department of Social Services to certify their annual reserves. This form verifies that the facility has met the required reserve amounts based on applicable regulations and guidelines. It ensures compliance with financial requirements and promotes transparency in reporting. By completing this form, facility operators provide assurance that they have maintained appropriate reserve levels, demonstrating fiscal responsibility and accountability.

The LIC 9279 form is a Pre-licensing Entrance Checklist specific to Child Care Centers in California. This checklist is used during the pre-licensing process to ensure that prospective child care centers meet all the necessary requirements for obtaining a license. It covers various aspects such as facility and equipment standards, health and safety measures, staffing qualifications, program policies and procedures, and documentation requirements.

The LIC 9263 Form 1-1 is used to document the resident population in various facilities regulated by the California Department of Social Services. This form captures details such as the number of residents, their demographics, special needs or considerations, and any relevant changes over time. It helps track and monitor the resident population, providing valuable information for facility management, resource allocation, and compliance purposes.