Home Care Organization Application Process

To apply for a license to operate a HCO, please complete the following steps:
Review the HCS 281 for application instructions.

1. Click on the links in the Section A chart below to access the appropriate application forms.

2. Complete the application forms and compile all the supplemental documents listed in the Section B chart.

Mail the completed application with appropriate application fees  to the HCSB at:

California Department of Social Services
Home Care Services Bureau
744 P Street, M.S. T8-3-90
Sacramento, CA 95814

Section A: Home Care Organization Application Forms

Section

Form Number

Description

A1

HCS 200

Application for a Home Care Organization License

A2

HCS 215

Licensee Applicant Information

A3

HCS 308

Designation of Home Care Organization Responsibility

A4

HCS 309

Partnership/Corporation/Limited Liability Company

A5

HCS 402

Employee Dishonesty Bond

A6

LIC 508

Criminal Record Statement

A7

HCS 9165

Board of Directors Statement

Section B: Supplemental Documents           

Section

Description

B1

Partnership Agreement/Articles of Incorporation/Articles of Organization

B2

Job Descriptions- Each Position

B3

Personnel Policies

B4

Training Plan

B5

Home Care Organization Program Description

B6

Insurance Information

After you submit your application, you will receive a notice stating that your
application has been received. This notice will also provide you with information regarding:

Your HCO number which you should use in all future communication;

How to commence with the fingerprinting process; and

How to complete the online orientation.