California Department of Social Services

Form LIC 402 is used to obtain a surety bond for licensed facilities in California. The form is completed by the facility operator or licensee and includes information about the bonding company, coverage amount, effective dates, and other relevant details. By utilizing this form, facility operators fulfill the requirement of maintaining a surety bond as mandated by licensing regulations, providing financial protection and security in case of any violations or issues within the facility.

Form LIC 01C is a confidential version of the Resource Family Application (LIC 01A). It serves the same purpose of collecting detailed information from prospective resource family applicants, but it includes additional sections that are kept confidential and not disclosed to the applicants. This form is used to gather sensitive information such as criminal history, child abuse clearance, and other confidential details necessary for the comprehensive assessment of the applicants.

Form LIC 281D is an application form used by individuals or organizations applying for a license to operate a foster family agency in California. The form is accompanied by a supporting documentation checklist that outlines the required documents and materials to be submitted along with the application. By utilizing this form and checklist, applicants can ensure that they provide all the necessary information and documentation required by the California Department of Social Services (CDSS) to evaluate their eligibility for a foster family agency license.

Form LIC 01A is the primary application form for individuals or families interested in becoming resource families. It gathers comprehensive information about the applicants, including personal details, household composition, employment history, references, and previous experience with childcare or foster care.

Form LIC 00A is an application form used during the process of converting a foster care home or licensed facility into a resource family. This form collects detailed information from the applicant regarding their personal background, qualifications, experience, and motivations for becoming a resource family.

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. The form ensures that consent is provided for the exchange of sensitive information, such as background checks, medical records, and other pertinent details, facilitating a smooth transition and compliance with legal and regulatory requirements.

Form LIC 281A is an application form accompanied by instructions specifically designed for individuals or organizations applying for a license to operate a child care center in California. The comprehensive form collects detailed information about the applicant, including personal details, program activities, staffing plans, health and safety measures, and other relevant information required for licensing.

Form KG 5 is a document used in the Kinship Guardianship Assistance Payments (Kin-GAP) program specifically related to nonrecurring legal guardianship expenses. It is completed by the relative caregiver to request reimbursement for one-time legal costs associated with establishing the guardianship. The form gathers necessary information about the incurred expenses, including legal fees, court filing fees, and other related costs.

Form LIC 198 is utilized by county licensed facilities in California to request a Child Abuse Central Index (CACI) check. The form is submitted to the California Department of Justice (DOJ) to conduct a background check on employees or potential employees to determine if they have been named in any substantiated child abuse or neglect reports. The LIC 198 form ensures that appropriate measures are taken to protect children by screening individuals working in county licensed facilities to prevent the employment of individuals who have been involved in child abuse or neglect incidents.

Form KG 4 is utilized in the Kinship Guardianship Assistance Payment (Kin-GAP) program to address nonrecurring legal guardianship expenses. It serves as an agreement between the relative caregiver and the California Department of Social Services (CDSS) regarding the reimbursement of one-time legal costs incurred during the establishment of the guardianship. The form outlines the eligible expenses, the documentation required for reimbursement, and the process for submitting and approving these expenses under the Kin-GAP program.