California Department of Social Services

The LIC 9275 form is an External Water Sampler Self-Certification Form used by water sampling professionals or entities responsible for collecting water samples for facilities regulated by the California Department of Social Services. This form verifies that the external water sampler meets the required qualifications, certifications, and training to ensure accurate and reliable water sample collection. It may include details such as the sampler's name, contact information, certifications held, sampling methods employed, and compliance with applicable regulations.

The LIC 9276 form is a Child Care Center Sampling Checklist Form used by the California Department of Social Services for monitoring and assessing child care centers within its jurisdiction. This checklist form assists in conducting inspections and audits of child care centers to ensure compliance with licensing requirements and standards. It covers various areas such as health and safety practices, staff qualifications, program activities, facility maintenance, emergency procedures, and recordkeeping.

The IC 9277LUA form, also known as the Guardian Licensee User Access Form, is used by the California Department of Social Services to authorize access to specific systems or information for individuals acting as guardians for licensees. This form allows designated guardians to access and manage licensee-related data, such as submitting reports, updating information, or communicating with the department on behalf of the licensee.

The LIC 9280 form is a Pre-licensing Entrance Checklist specifically designed for Family Child Care Homes in California. This checklist is used during the pre-licensing process to ensure that prospective family child care homes meet all the necessary requirements for obtaining a license. It covers various aspects such as safety measures, health and sanitation standards, caregiving qualifications, program policies and procedures, emergency preparedness, and documentation requirements.

Form LIC 9211 is used by child care providers in California to request an inactive status for their child care license. This form is typically utilized when a provider temporarily suspends their child care services and wants to maintain their license without actively operating. By submitting this form, providers communicate their intention to put their child care license on hold while they are not providing child care services. This allows them to retain their license for future use without having to go through the full application process again.

Form LIC 9224 is used to acknowledge the receipt of licensing reports by child care providers in California. The form is typically provided to providers after a licensing visit or inspection, and it confirms that they have received copies of the reports detailing the findings and any actions required for compliance. By signing this acknowledgment form, child care providers demonstrate their awareness of the licensing reports and their commitment to addressing any deficiencies or areas needing improvement identified during the inspection process.

Form LIC 9225 is used in foster care and adoption settings in California as part of the pre-placement process. The form collects detailed information about prospective foster parents or adoptive families, including personal background, family dynamics, parenting skills, preferences, and experience with children. This questionnaire helps assess the suitability of families for providing a safe and nurturing environment for children in need of foster care or permanent placement.

Form LIC 9226 is utilized to request approval for mandated child abuse reporter training in California. This form is typically completed by organizations or individuals offering training programs on recognizing and reporting child abuse and neglect. It collects information about the training provider, course content, duration, objectives, instructional methods, and qualifications of the trainers.

The LIC 9229 form is a comprehensive checklist designed for Licensing Program Managers within the California Department of Social Services. It serves as a guide for conducting complaint reviews related to various licensed facilities or programs. This checklist assists Licensing Program Managers in systematically assessing the nature of the complaint, gathering relevant information, evaluating compliance with regulations and policies, conducting investigations, and making informed decisions based on the findings.

Form LIC 9182 is used to request the transfer of a criminal background clearance for individuals who have previously been cleared for employment or volunteer positions in care facilities in California. This form is typically utilized when an individual changes positions or moves to a different facility within the same organization. By completing this form, care facilities initiate the process of transferring the existing criminal background clearance to ensure continuity in the screening process and compliance with licensing regulations.