California Department of Social Services

Form LIC 215TM is an application information form specifically designed for individuals seeking to be included on the temporary manager candidate list. It is used by individuals interested in serving as temporary managers for licensed facilities within the jurisdiction of the California Department of Social Services (CDSS). The form gathers essential information such as the applicant's qualifications, experience, and availability as a temporary manager.

Form LIC 215 is an information form used by applicants applying for various licenses or certifications within the California Department of Social Services (CDSS). The form collects personal information about the applicant, including their name, contact details, identification documents, and other necessary details required for processing the application. By utilizing this form, the CDSS ensures accurate record-keeping and efficient communication with applicants throughout the licensing process.

Form LIC 200A is an application form used by individuals or organizations seeking a license to operate a child care center in California. The form collects detailed information about the applicant, including personal details, proposed program activities, staffing plans, health and safety measures, and other relevant information required for licensing. By utilizing this form, the California Department of Social Services (CDSS) evaluates the applicant's suitability and capacity to provide quality child care services in a safe and nurturing environment.

Form LIC 200TM is a temporary manager application form specifically intended for the provision of a provisional license. It is utilized by individuals applying to serve as temporary managers for community care facilities or residential care facilities for the elderly in California. The form gathers essential information about the applicant's qualifications, experience, and capacity to assume managerial responsibilities during the transitional phase of a facility.

Form LIC 184B is a notification form used by the California Department of Social Services (CDSS) to inform applicants for family child care home licenses about incomplete application submissions. This form outlines the specific areas or documentation that are missing or incomplete and must be addressed to proceed with the licensing process. By using this form, the CDSS ensures that applicants are aware of the deficiencies in their application and can take necessary steps to rectify them, ensuring compliance with licensing requirements.

Form LIC 165 is a board of directors statement that may be required for certain organizations or entities involved in child welfare services. It is typically utilized by agencies or programs seeking licensure or certification from the California Department of Social Services (CDSS). The form includes a statement prepared by the board of directors, affirming their commitment to the objectives, policies, and ethical standards of the organization. This document ensures accountability and transparency in the governance and operations of child welfare agencies or programs.

Form IHSS-E-004 is a notice issued by the In-Home Supportive Services (IHSS) program to inform providers about the non-receipt of their exemption from workweek limits provider agreement. It notifies the provider that the agreement, which grants them the flexibility to work beyond the standard limits, has not been received or processed. This form aims to address any potential administrative issues or oversights, allowing the provider and the program administrators to rectify the situation and ensure compliance with the established regulations.

Form LIC 126 is an entrance checklist utilized for family child care homes. It is employed by licensing personnel to assess the compliance of family child care homes with licensing requirements and standards. The checklist encompasses multiple areas, including health and safety measures, caregiver qualifications, communication with parents, and the provision of developmental activities. This form enables the California Department of Social Services (CDSS) to ensure that family child care homes provide a safe and supportive environment for children under their care.

Form LIC 300D is used to confirm the removal of a child from a licensed facility when the removal is determined to be non-exemptible from further licensing requirements. The form is completed by the California Department of Social Services (CDSS) to document and confirm the child's removal from the facility. By utilizing this form, the CDSS acknowledges that the removal is not eligible for exemption from certain licensing provisions, and appropriate steps may need to be taken to ensure compliance with applicable regulations.

Form LIC 125 is an entrance checklist specifically designed for child care centers. It is used during the licensing process and assists licensing personnel in conducting comprehensive inspections of child care center facilities. The checklist covers various areas, including health and safety standards, staff qualifications, program policies, and supervision protocols. By utilizing this form, the California Department of Social Services (CDSS) ensures that child care centers comply with regulations and provide a safe and nurturing environment for children attending the facility.