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- LIC 01A (6/23) - Resource Family Application
- LIC 01C (7/16) - Resource Family Application-Confidential
- LIC 03 (7/23) - Resource Family Home Health And Safety Assessment Checklist Document For Agency Use Only
- LIC 05A (8/21) - Resource Family Approval Certificate
- LIC 08 (2/24) - Intensive Services Foster Care Unit (ISFC) Written Assessment of Risk and Compatibility
- LIC 12 (8/21) - Resource Family Approval Document Alternative Plan (DAP)
- LIC 122 (1/08) - Release Of Information
- LIC 125 (3/21) - Entrance Checklist - Child Care Centers
- LIC 126 (3/21) - Entrance Checklist - Family Child Care Homes
- LIC 165 (8/07) - Board Of Directors Statement
- LIC 184 (5/00) - Notification Of Incomplete Application
- LIC 184B (3/23) - Notification Of Incomplete Application - Family Child Care Home
- LIC 184C (3/23) - Notification Of Incomplete Application (NOIA) Child Care Centers - Pre-30-Day NOIA
- LIC 184D (3/23) - Notification Of Incomplete Application (NOIA) Child Care Centers - 30-Day NOIA
- LIC 184E (3/23) - Notice Of Incomplete Application (NOIA) Changes To Corporate Status
- LIC 185 (5/99) - Contact Sheet
- LIC 186A (10/04) - Orientation Meeting Family Child Care Home
- LIC 192 (7/03) - Notification Of Initial Application Denial
- LIC 195 (8/19) - Notice Of Operation In Violation Of Law
- LIC 195A (8/19) - Notice Of Operation In Violation Of Law - Family Child Care Home
- LIC 198 (1/22) - Child Abuse Central Index Check For County Licensed Facilities
- LIC 198B (9/23) - Out-Of-State Child Abuse/Neglect Report Request
- LIC 200 (2/24) - Application For A Community Care Facility or Residential Care Facility For The Elderly License
- LIC 200TM (6/18) - Temporary Manager Application For Provisional License
- LIC 200A (1/25) - Application for a Child Care Center License
- LIC 201F (2/01) - Annual License Fee Notice - County
- LIC 215 (12/22) - Applicant Information
- LIC 215TM (11/18) - Temporary Manager Candidate List Application Information
- LIC 216TM (11/18) - Temporary Manager Appointment Applicant Information
- LIC 279 (2/23) - Application For A Family Child Care Home License
- LIC 279A (6/24) - License Application And Instructions For Family Child Care Homes
- LIC 279B (1/22) - Current Children In Your Home - Application For A Family Child Care Home License
- LIC 281 (6/24) - Application Instructions for A Facility License
- LIC 281A (2/24) - License Application And Instructions For Child Care Centers
- LIC 281D (2/24) - Application And Supporting Documentation Checklist Foster Family Agency
- LIC 281E (12/24) Application And Supporting documentation Checklist Short - Term Residential Therapeutic Program
- LIC 282 (1/22) - Affidavit Regarding Liability Insurance For Family Child Care Home
- LIC 300A (9/25) - Removal Confirmation - Exemption Needed
- LIC 300B (9/25) - Removal Confirmation - Denial
- LIC 300E (12/03) - Removal Confirmation - County
- LIC 301 (8/99) - Reference Request
- LIC 301E (10/22) - Reference Request - Exemption
- LIC 306 (3/01) - Reporting Requirements By Licensees To The State Department Of Social Services
- LIC 308 (11/02) - Designation Of Facility Responsibility
- LIC 309 (6/01) (PUBLIC) - Administrative Organization
- LIC 311A (2/22) - Records To Be Maintained At The Facility - Child Care Centers, Infant Centers, School-Age Centers and Child Care Centers For Mildly Ill Children
- LIC 311B (4/05) - Records To Be Maintained By The Facility - Group Homes
- LIC 311C (4/05) - Records To Be Maintained At The Facility - Adult Residential
- LIC 311D (2/22) - Forms/Records To Keep In Your Family Child Care Home
- LIC 311E (4/05) - Records To Be Maintained At The Facility - Small Family Home And Foster Family Home
- LIC 311F (4/05) - Records To Be Maintained At The Facility - Residential Care Facility For The Elderly
- LIC 313 (12/01) - Evidence Of Program Consultant
- LIC 400 (1/99) - Affidavit Regarding Client/Resident Cash Resources
- LIC 401 (3/01) - Monthly Operating Statement
- LIC 401A (3/99) - Supplemental Financial Information
- LIC 402 (8/04) - Surety Bond
- LIC 403 (7/11) - Balance Sheet
- LIC 403A (9/11) - Balance Sheet Supplemental Schedule
- LIC 404 (7/99) - Financial Information Release And Verification
- LIC 405 (8/01) - Record Of Client's/Resident's Safeguarded Cash Resources
- LIC 406 (5/13) - Client/Resident Cash Sheet
- LIC 420 (4/99) - Budget Information
- LIC 421A (3/24) - Civil Penalty Assessment (Unlicensed Facility)
- LIC 421BG (5/19) - Civil Penalty Assessment – Caregiver Background Check
- LIC 421CC (6/22) - Civil Penalty Assessment – Child Care
- LIC 421D (ASC) (6/17) - Civil Penalty Assessment – Death/Serious Bodily Injury/Physical Abuse (ASC)
- LIC 421D (CC) (8/22) - Civil Penalty Assessment – Death/Serious Injury/Physical Abuse (Child Care)
- LIC 421D (CRP) (6/17) - Civil Penalty Assessment – Death/Serious Bodily Injury/Physical Abuse (CRP)
- LIC 421FC (7/17) - Civil Penalty Assessment – Failure To Correct And Repeat Violations
- LIC 421IM (7/17) - Civil Penalty Assessment – Immediate $500 And Repeat Violations
- LIC 422 (9/11) - Notice Of Civil Penalties Due
- LIC 422A (10/11) - Civil Penalty Ledger
- LIC 424 (1/03) - Record Of Client's Cash Resources For Change Of Licensee
- LIC 500 (11/03) - Personnel Report
- LIC 501 (3/99) - CCL/Personnel Record
- LIC 503 (6/24) - Health Screening Report - Facility Personnel
- LIC 507 (1/00) - Facilities Staff Work Schedule
- LIC 508 O-O-S (9/23) - Out-Of-State Disclosure
- LIC 508D (10/23) - Out-Of-State Disclosure And Criminal Record Statement
- LIC 601 (8/08) - Identification And Emergency Information
- LIC 602 (7/22) - Physician's Report For Community Care Facilities
- LIC 602A (4/25) - Medical Assessment for Residential Care Facilities for the Elderly
- LIC 603 (6/22) - Preplacement Appraisal Information
- LIC 603A (7/99) - Resident Appraisal
- LIC 604 (10/05) - Admission Agreement Guide For Residential Facilities
- LIC 604A (2/05) - Admission Agreement For Residential Care Facilities For The Elderly
- LIC 605A (7/22) - Release Of Client/Resident Medical Information
- LIC 606 (8/18) - Residential Care Facility For The Elderly Disclosure Worksheet
- LIC 610 (11/23) - Emergency Disaster Plan For Child Care Centers
- LIC 610A (01/22) - Emergency Disaster Plan For Family Child Care Homes
- LIC 610C (10/03) - Emergency Disaster Plan For Children's Residential Facilities (Except Foster Family Homes)
- LIC 610D (12/21) - Emergency Disaster Plan For Adult Day Programs, Adult Residential Facilities, Residential Care Facilities For The Chronically Ill And Social Rehabilitation Facilities
- LIC 610E (3/19) - Emergency Disaster Plan For Residential Care Facilities For The Elderly
- LIC 613 (12/02) - Personal Rights Adult Residential Care Facilities
- LIC 613A (12/25) - Personal Rights - Child Care Centers - Use as of December 18, 2025
- LIC 613B (6/22) - Personal Rights Children’s Residential Facilities
- LIC 613C (1/19) - Personal Rights Of Residents In Publicly Operated Residential Care Facilities For The Elderly
- LIC 613C-2 (3/25) - Personal Rights Of Residents In Privately Operated Residential Care Facilities For The Elderly
- LIC 621 (4/99) - Client/Resident Personal Property And Valuables
- LIC 622 (9/19) - Centrally Stored Medication And Destruction Record
- LIC 622A (6/17) - Medication Administration Record (MAR)
- LIC 622B (5/17) - Psychotropic Medication Administration Record (MAR)
- LIC 623 (5/01) - Group Planned Activities
- LIC 624 (4/99) - Unusual Incident/Injury Report
- LIC 624A (7/99) - Death Report
- LIC 624B (8/08) - Unusual Incident/Injury Report - Family Child Care Home
- LIC 624 LE (12/22) - Law Enforcement Contact Report
- LIC 625 (10/24) – Appraisal/Needs and Services Plan
- LIC 627 (9/08) - Consent For Emergency Medical Treatment - Child Care Centers Or Family Child Care Homes
- LIC 627B (9/08) - Consent For Emergency Medical Treatment - Children's Residential Facilities
- LIC 627C (4/00) - Consent For Emergency Medical Treatment - Adult And Elderly Residential Facilities
- LIC 700 (10/19) - Identification And Emergency Information Child Care Centers/Family Child Care Homes
- LIC 701 (8/08) - Physician's Report - Child Care Centers
- LIC 701A (9/00) - Gastrostomy - Tube Care: Physician's Checklist (Child Care Facilities)
- LIC 701B (9/00) - Gastrostomy - Tube Care Consent/Verification (Child Care Facilities)
- LIC 702 (10/19) - Child's Preadmission Health History - Parent/Authorized Representative Report
- LIC 809 (9/23) - Facility Evaluation Report
- LIC 811 (8/06) - Confidential Names
- LIC 812 (8/06) - Detail Supportive Information
- LIC 813 (5/24) - Facility Photography Report
- LIC 855 (9/00) - Declaration
- LIC 856A (3/21) - Complaint Intake Notification
- LIC 856B (3/21) - Complaint Determination Notification - Substantiated
- LIC 856C (3/21) - Complaint Determination Notification - Unsubstantiated
- LIC 856D (3/21) - Complaint Determination Notification - Unfounded
- LIC 857 (8/06) - Children's Record Review
- LIC 858 (10/99) - Client/Resident Records Review (Residential)
- LIC 859 (8/06) - Review of Staff/Volunteer
- LIC 907 (5/00) - Transmittal For Processing
- LIC 957 (10/99) - Complaint Control Log
- LIC 972 (5/00) - Individual Waiver/Exception Log
- LIC 986A (10/99) - Notice Of Revocation Action
- LIC 989 (11/02) - Information Request
- LIC 989A (3/17) - Non-Confidential Records Request Form
- LIC 995 (9/08) - Child Care Center - Notification Of Parents' Rights
- LIC 995A (8/08) - Family Child Care Home - Notification Of Parents' Rights
- LIC 995B (8/08) - Family Child Care Home Addendum To Notification Of Parents' Rights (Regarding Removal/Exclusion)
- LIC 995C (8/08) - Family Child Care Home Addendum To Notification Of Parents' Rights (Regarding Reinstatement)
- LIC 995D (5/03) - Family Child Care Home Explanation Of Removal/Exclusions And Reinstatement
- LIC 995E (10/09) - Important Information For Parents
- LIC 995F (10/09) - Caregiver Background Check Information
- LIC 999 (3/99) - Facility Sketch (Floor Plan)
- LIC 999A (2/05) - Facility Sketch (Floor Plan) - Family Child Care Home
- LIC 9015 (9/00) - Legal Case Transmittal
- LIC 9020 (5/17) - Register Of Facility Clients/Residents
- LIC 9020A (6/17) - Register Of Facility Residents - Residential Care Facilities For The Elderly
- LIC 9031 (11/99) - Notice Of Temporary Suspension Order Of License
- LIC 9040 (10/05) - Child Care Facility Roster
- LIC 9052 (1/22) - Notice Employee Rights
- LIC 9054 (3/99) - Local Fire Inspection Authority Information
- LIC 9058 (3/22) - Applicant/Licensee Rights
- LIC 9059 (5/99) - Personal Property Procedures
- LIC 9060 (2/00) - Resident Theft And Loss Record
- LIC 9092 (2/11) - Fire Pre-Inspection/Consultation Request
- LIC 9095 (6/99) - Evaluation Of Teacher Qualifications
- LIC 9096 (2/00) - Evaluation Of Director Qualifications
- LIC 9098 (4/09) - Proof Of Correction(s)
- LIC 9099 (12/16) - Complaint Investigation Report
- LIC 9102TA (2/19) - Advisory Notes - Technical Assistance
- LIC 9102TV (2/19) - Advisory Notes - Technical Violation
- LIC 9106 (11/19) - Group Home Program Statement General Instructions
- LIC 9106A (9/24) - Short-Term Residential Therapeutic Program
- LIC 9108 (3/05) - Statement Acknowledging Requirement To Report Suspected Child Abuse
- LIC 9111 (12/99) - Noncompliance Conference Summary
- LIC 9112 (9/21) - Facility Compliance Plan
- LIC 9118 (6/21) - Facility Inspection Checklist Checklist Child Care Centers
- LIC 9119 (10/22) – Facility Inspection Checklist Group Homes
- LIC 9119 AA (7/22) - Facility Inspection Checklist Adoption Agency
- LIC 9119 CCH (11/22) - Facility Inspection Checklist Community Crisis Home
- LIC 9119 CN (8/22) - Facility Inspection Checklist Crisis Nurseries
- LIC 9119 CTF (1/22) – Facility Inspection Checklist Community Treatment Facility
- LIC 9119 EBSH (4/22) - Facility Inspection Checklist Enhanced Behavioral Supports Homes
- LIC 9119 TrSCF (12/22) - Facility Inspection Checklist Transitional Shelter Care Facility
- LIC 9119 YHPC (4/22) - Facility Inspection Checklist Youth Homelessness Prevention Center
- LIC 9120A (2/20) - Licensed Facility Inspection Checklist Adult Care Facilities
- LIC 9121 (7/21) - Facility Visit Checklist Family Child Care
- LIC 9122A (7/20) – Facility Inspection Checklist Small Family Home
- LIC 9123 (2/20) - Facility Inspection Checklist - Residential Care Facility For The Elderly
- LIC 9128 (5/23) - Foster Family Agency Program Statement
- LIC 9139 (3/23) - Renewal Of Continuing Education Course Approval - Administrator Certification Program
- LIC 9140 (3/24) - Request For Course Approval - Administrator Certification Program
- LIC 9140A (3/23) - Request to Add or Replace Instructor
- LIC 9141 (6/23) - Vendor Application/Renewal - Administrator Certification Program
- LIC 9142A (3/23) - Roster of Participants
- LIC 9148 (9/00) - Earthquake Preparedness Checklist (EPC)
- LIC 9149 (8/14) - Family Child Care Home Property Owner/Landlord Consent Form
- LIC 9150 (8/14) - Parent Notification - Additional Children in Care
- LIC 9151 (8/14) - Property Owner/Landlord Notification Family Child Care Home
- LIC 9158 (7/22) - Telecommunications Device Notification
- LIC 9163 (1/25) - Request Live Scan Service - Community Care Licensing
- LIC 9163B (11/22) - Request Live Scan Service - Long Term Care OMBUDSMAN
- LIC 9165 (4/22) - Board Of Director Statement
- LIC 9166 (2/01) - Nebulizer Care Consent/Verification (Child Care Facilities)
- LIC 9172 (8/01) - Functional Capability Assessment
- LIC 9182 (11/23) - Criminal Background Clearance Transfer Request
- LIC 9186 (2/01) - Client Death Report
- LIC 9187 (7/00) - Child Care Client Death Report
- LIC 9188 (11/23) - Criminal Record Exemption Transfer Request
- LIC 9200 (9/11) - Pre-Licensing Facility Evaluation Checklist
- LIC 9211 (9/21) - Request For Inactive Child Care License Status
- LIC 9212 (10/05) - Consumer Awareness Information - Family Child Care
- LIC 9213 (1/04) - Notice Of Site Visit By A Child Care Licensing Office Representative
- LIC 9214 (7/25) - Application for Administration Certification - Administrator Certification Program
- LIC 9216 (3/17) - Complaint And Type A Violation Log
- LIC 9217 (5/22) - Pre-Licensing Readiness Guide - Family Child Care Home
- LIC 9219 (3/16) - Crisis Nursery Monthly Report
- LIC 9219A (3/16) - Crisis Day Care Sign-In
- LIC 9221 (5/22) - Parent Consent For Administration Of Medications And Medication Chart
- LIC 9222 (9/05) - Blood Glucose Testing Consent/Verification Child Care Facilities
- LIC 9224 (8/08) - Acknowledgement Of Receipt Of Licensing Reports
- LIC 9225 (4/10) - Pre-Placement Questionnaire
- LIC 9226 (5/18) - Request For Training Approval: Mandated Child Abuse Reporter Training
- LIC 9227 (8/20) - Individual Infant Sleeping Plan
- LIC 9229 (7/21) - Licensing Program Manager (LPM) Checklist For Complaint Review
- LIC 9230 (7/21) - Licensing Program Analyst (LPA) Checklist For Complaint Review
- LIC 9233 (7/20) – Facility Inspection Checklist Foster Family Agencies
- LIC 9234 (5/23) – Entrance Checklist Foster Family Agency
- LIC 9235 (10/22) – Facility Inspection Checklist Short – Term Residential Therapeutic Program
- LIC 9236 (6/23) – Entrance Checklist Short – Term Residential Therapeutic Program
- LIC 9237 (7/20) – Facility Inspection Checklist Transitional Housing Placement Program
- LIC 9238 (5/23) – Entrance Checklist Transitional Housing Placement Program
- LIC 9239 (5/23) – Entrance Checklist Group Home
- LIC 9239 AA (12/22) – Entrance Checklist Adoption Agency
- LIC 9239 CCH (3/23) - Entrance Checklist - Community Crisis Homes
- LIC 9239 CN (3/23) - Entrance Checklist - Crisis Nurseries
- LIC 9239 CTF (3/23) - Entrance Checklist Community Treatment Facility
- LIC 9239 EBSH (3/23) - Entrance Checklist - Enhanced Behavioral Supports Homes
- LIC 9239 TrSCF (3/23) - Entrance Checklist - Transitional Shelter Care Facility
- LIC 9239 YHPC (3/23) - Entrance Checklist - Youth Homelessness Prevention Center
- LIC 9240 (6/23) – Entrance Checklist Small Family Home
- LIC 9241 (2/20) - Entrance Checklist Adult Care Facilities
- LIC 9242 (9/19) - Entrance Checklist Residential Care Facilities For The Elderly
- LIC 9263 (8/23) – Form 1-1: Resident Population
- LIC 9264 (3/21) – Form 1-2: Annual Provider Fee
- LIC 9265 (6/21) – Form 5-1: Long-Term Debt Incurred In A Prior Year (Including Balloon Debt)
- LIC 9266 (3/21) – Form 5-2: Long-Term Debt Incurred During Fiscal Year (Including Balloon Debt)
- LIC 9267 (3/21) – Form 5-3: Calculation Of Long-Term Debt Reserve Amount
- LIC 9268 (6/21) – Form 5-4: Calculation Of Net Operating Expenses
- LIC 9269 (3/21) – Form 5-5: Annual Reserve Certification
- LIC 9270 (9/22) – Form 7-1: Report On CCRC Monthly Care Fees
- LIC 9271 (6/21) – Form 9-1: Calculation Of Refund Reserve Amount
- LIC 9272 (11/21) – Annual Report Checklist
- LIC 9273 (7/23) – Continuing Care Retirement Community Disclosure Statement
- LIC 9274 (11/21) – Key Indicators Report
- LIC 9275 (6/21) - External Water Sampler Self-Certification Form
- LIC 9276 (7/21) – Child Care Center Sampling Checklist Form
- LIC 9277LUA (8/23) - Guardian Licensee User Access Form
- LIC 9279 (10/21) - Pre-licensing Entrance Checklist - Child Care Centers
- LIC 9280 (10/21) - Pre-licensing Entrance Checklist - Family Child Care Homes
- LIC 9282 (6/23) – Residential Infection Control Plan - Adult Residential Facilities, Enhanced Behavioral Supports Homes, Community Crisis Homes, Residential Care Facilities for the Elderly, Residential Care Facilities for the Chronically Ill, and Social Rehabilitation Facilities
- LIC 9283 (6/23) - Infection Control Plan - Adult Day Programs