California Department of Social Services

Form LIC 306 is used by licensees of social services facilities in California to fulfill reporting requirements to the State Department of Social Services (CDSS). The form outlines the specific information, incidents, or events that must be reported, as required by applicable regulations and licensing standards. By utilizing this form, licensees provide timely and accurate reports to the CDSS, ensuring compliance with reporting obligations and facilitating transparency and accountability in the operation of licensed facilities.

Form LIC 301E is a reference request form used for requesting references related to exemption applications in California. The form is completed by the California Department of Social Services (CDSS) or the facility operator to collect references that support an exemption application. It gathers information about the individual or entity seeking an exemption from specific licensing requirements and their suitability for receiving such an exemption.

Form LIC 301B is a reference request form specifically used by the Long-Term Care Ombudsman Program in California. The form is completed by the program to gather references for individuals applying for positions within the program. It collects information about the applicant's character, qualifications, and suitability for the position from the provided references. By utilizing this form, the Long-Term Care Ombudsman Program obtains valuable insights to make informed decisions regarding the applicant's suitability for employment or volunteer roles within the program.

Form LIC 301A is a specific reference request form used for adoption facilitators in California. The form is completed by the California Department of Social Services (CDSS) or the adoption agency to request references for an adoption facilitator. The form collects information about the facilitator's professional background, experience, and character from the provided references. By utilizing this form, the CDSS or the adoption agency gathers essential information to assess the adoption facilitator's qualifications and suitability for assisting in adoption processes.

Form LIC 300E is used by county agencies to confirm the removal of a child from a licensed facility. The form is completed by the county agency responsible for overseeing child welfare services to officially notify the licensee or facility operator about the child's removal. By utilizing this form, the county agency communicates the decision to remove the child and provides relevant details regarding the transfer or placement of the child in another facility or care setting.

Form LIC 281 provides detailed instructions for individuals or organizations applying for a facility license in California. The form guides applicants through the application process, explaining the necessary steps, required documentation, and specific requirements for obtaining a facility license. By utilizing this form, applicants can ensure that they have a clear understanding of the application procedure and meet all the necessary criteria set forth by the California Department of Social Services (CDSS) to obtain a facility license.

Form LIC 279B is an application form used in conjunction with LIC 279 for family child care home licenses. It specifically focuses on gathering information about the current children residing in the applicant's home. The form requires details such as the names, ages, and relationships of the children, as well as other specific information related to their care and supervision.

Form LIC 279A is a license application form specifically designed for family child care homes. It provides applicants with instructions on how to complete the application process accurately. The form covers various sections, including personal information, program details, health and safety measures, and required documentation. By utilizing this form, applicants are guided through the application process, ensuring that all necessary information is provided to the California Department of Social Services (CDSS) for the evaluation and approval of a family child care home license.

Form LIC 279 is an application form used by individuals or entities applying for a family child care home license in California. The comprehensive form gathers detailed information about the applicant, including personal details, background information, proposed program activities, health and safety measures, and other relevant information required for licensing. By utilizing this form, the California Department of Social Services (CDSS) assesses the applicant's suitability and capacity to operate a family child care home that meets the state's licensing requirements.

Form LIC 216TM is an applicant information form used for individuals seeking temporary manager appointments within licensed facilities in California. The form collects detailed information about the applicant, including personal details, qualifications, experience, and availability. It serves as a comprehensive record of prospective temporary managers and assists the California Department of Social Services (CDSS) in evaluating candidates for temporary managerial positions.