2005 Notice Of Form Changes

  • 05-161
    LIC 9223 SP (11/05) - Child Care Advocate Program
  • 05-160
    LIC 279 (1/06) - Application For A Family Child Care Home License
  • 05-159
    AD 590A (12/05) - Waiver Of Right To Further Notice Of Adoption Planning (Presumed Father In Or Out Of California)
  • 05-158
    PUB 394 (12/05) - Notification of Parents' Rights Poster
  • 05-157
    LIC 995A (12/05) - Notification Of Parent's Rights - Family Child Care Homes
  • 05-156
    CW 2197 (12/05) - Timing Out Questionnaire Stage One CalWORKs Child Care
  • 05-155
    LIC 279B English & Spanish (10/05) - Current Children In Your Home - Application For A Family Child Care Home License
  • 05-154
    LIC 9016 (4/01) - Investigator's Monthly Time And Statistical Report
  • 05-153
    LIC 9008 (9/99) - Investigation Chronology
  • 05-152
    PUB 341 (9/05) - Adoptions Services Bureau Career Opportunities
  • 05-151
    DPA 19 (12/05) - Authorized Representative
  • 05-150
    LIC 279A (11/05) - Application Instructions For A Family Child Care Home License
  • 05-149
    CA 800M (11/05) - Summary Report Of Assistance Expenditures, CalWORKs Assistance, Recent Non-Citizen, Mixed Cases
  • 05-148
    CA 800 FC1B (11/05) - Foster Care Out-Of-State Facility Report
  • 05-147
    CA 800M1 (11/05) - CalWORKs Assistance, Recent Non-Citizens Mixed Cases Case Count Information
  • 05-146
    LIC 195A (10/05) - Notice Of Operation In Violation Of Law - Family Child Care Home
  • 05-145
    LIC 195 (10/05) - Notice Of Operation In Violation Of Law
  • 05-144
    LIC 604 (10/05) - Admission Agreement Guide For Residential Facilities
  • 05-143
    LIC 995A Spanish (9/05) - Notification Of Parent's Rights Family Child Care Homes
  • 05-142
    LIC 9222 Spanish (9/05) - Blood Glucose Testing Consent/Verification Child Care Facilities
  • 05-141
    CCP 7 English & Spanish (10/05) - CalWORKs Stage One Child Care Informing Notice And Request Form
  • 05-140
    TLR 2 (10/05) - Trustline Application - Voluntary Applicants
  • 05-139
    SOC 448 (10/05) - In-Home Supportive Services Program Public Authority Invoice Admin Costs
  • 05-138
    SAWS 2A QR (9/05) - Rights And Responsibilities And Other Important Information
  • 05-137
    LIC 9222 (9/05) - Blood Glucose Testing Consent/Verification Child Care Facilities
  • 05-136
    LIC 995A (9/05) - Notification Of Parents' Rights - Family Child Care Home
  • 05-135
    SOC 317 (4/00) - In Home Supportive Services Batch Cover Sheet
  • 05-134
    SOC 405A (10/05) - Independent Living Program (ILP) Annual Statistical Report Federal Fiscal Year October 1 Through September 30
  • 05-133
    SOC 821 (11/05) - Assessment Of Need For Protective Supervision For In-Home Supportive Services Program
  • 05-132
    SSP 17 (4/99) - Notice Of Hearing And Right To Request A State Hearing On Interim Assistance
  • 05-131
    SOC 814 English & Spanish (11/02) - Statement Of Facts Cash Assistance Program For Immigrants (CAPI)
  • 05-129
    LIC 9212 (10/05) - Consumer Awareness Information - Family Child Care
  • 05-128
    LIC 311A (9/05) - Records To Be Maintained At The Facility - Child Care Centers, Infant Centers, School-Age Centers and Child Care Centers For Mildly Ill Children
  • 05-126
    LIC 9058 SP (8/05) - Applicant/Licensee Rights
  • 05-125
    LIC 613C SP (7/05) - Personal Rights - Residential Care For The Elderly
  • 05-124
    LIC 9223 (11/05) - Child Care Advocate Program
  • 05-123
    TEMP 2220 (10/04) - Statistical Report On The Number Of Children Ages 5-17 In Families Receiving Cash Assistance
  • 05-122
    NA 1240 English & Spanish (5/05) - Notice Of Action - Food Stamp Overissuance And Dormant EBT Account
  • 05-121
    LIC 9058 (08/05) - Applicant/Licensee Rights
  • 05-120
    CA 800 FC FED (9/05) - Summary Report Of Assistance Expenditures - Foster Care; Foster Care SB 163, Federal
  • 05-118
    TEMP 2224 English & Spanish (9/05) - Application For Food Stamp Benefits For Evacuees Of Hurricane Katrina
  • 05-117
    NA 1205 English & Spanish (1/00) - Notice Of Action - Overpayment Reimbursement Claim
  • 05-116
    LIC 311D SP (6/05) - Forms/Records To Be Kept In Your Family Child Care Home
  • 05-115
    SOC 452A (8/05) - Cash Assistance Program For Immigrants (CAPI) Income Eligibility - Child
  • 05-114
    SOC 450 English & Spanish (4/99) - Voluntary Services Certificate
  • 05-113
    BCII 9002 (8/05) - Substitute Agency Notification Request
  • 05-111
    NOT USED
  • 05-110
    FS 11 English & Spanish (8/05) - Notice To All Food Stamp Recipients
  • 05-109
    LIC 9221 (6/05) - Parent Consent For Administration Of Medications And Medication Chart
  • 05-108
    LIC 613A Spanish - Personal Rights - Child Care Centers
  • 05-107
    CA 800 FC FED (8/05) - Summary Report Of Assistance Expenditures - Foster Care; Foster Care SB 163, Federal
  • 05-106
    VARIOUS FORMS THAT ARE NOW OBSOLETE (SEE LIST)
  • 05-105
    NOT USED
  • 05-104
    VARIOUS FORMS THAT ARE NOW OBSOLETE (SEE ATTACHED LIST)
  • 05-103
    GEN 387A (8/02) - Request For Manual Of Policies And Procedures; GEN 387B (10/03) - Request For Regulations Title 22, Division 6 And 12 Community Care Licensing (For Licensees, Provider Associations and Organizations Use Only); and GEN 387C (10/03) - Request For Regulations Title 22, Division 6 And 12 Community Care Licensing (For State And County Licensing Office Use Only)
  • 05-102
    LIC 610A English & Spanish (6/05) - Emergency Disaster Plan For Family Child Care Homes
  • 05-101
    LIC 421B (7/05) - Civil Penalty Assessment (Criminal Background Clearance)
  • 05-100
    NOT USED
  • 05-099
    FCR 16 (2/05) - Group Home Shelter Costs, Self-Dealing Transactions Declaration And Survey
  • 05-098
    TLR 2 (7/05) - Trustline Application - Voluntary Applicants
  • 05-097
    LIC 613C (7/05) - Personal Rights - Residential Care For The Elderly
  • 05-096
    CA 800 FC FED PIA (7/05) - Foster Care Placement Information Addendum (PIA) Federal
  • 05-095
    LIC 311D - Forms/Records To Be Kept In Your Family Child Care Home
  • 05-094
    LIC 311A - Records To Be Maintained At The Facility - Child Care Centers
  • 05-093
    LIC 9211 - Request For Inactive Child Care License Status
  • 05-092
    LIC 613A - Personal Rights - Child Care Centers
  • 05-091
    CW 2103 English & Spanish (8/01) - Reminder For Teens Turning 18 Years Old
  • 05-090
    LIC 995E Spanish (6/05) - Caregiver Background Check Process
  • 05-089E
    Errata to QR 2103 English & Spanish (5/05) - Reminder For Teens Turning 18 Years Old
  • 05-089
    QR 2103 English & Spanish (5/05) - Reminder For Teens Turning 18 Years Old
  • 05-088
    ABCD 350 (7/05) - Ethnic Origin And Primary Language Report [ABCD 350 (7/05)] For July 2005
  • 05-086
    SOC 814 (11/02) - Statement Of Facts - Cash Assistance Program For Immigrants (CAPI)
  • 05-085
    PUB 132 English & Spanish (1/05) - The California Child Abuse & Neglect Report Law
  • 05-084
    AD 558 (6/05) - Notice Of Placement
  • 05-083
    SOC 423 (8/99) - Emergency Response Protocol
  • 05-082
    DFA 358S (7/05) - Food Stamp Program Participants By Ethnic Group / State Only
  • 05-081
    DFA 358F (7/05) - Food Stamp Program Participants By Ethnic Group/Federal-Only And Continued Households
  • 05-080
    LIC 9151 SP (3/05) - Property Owner/Landlord Notification - Family Chld Care Home
  • 05-079
    LIC 9150 SP (3/05) - Parent Notification - Additional Children In Care
  • 05-078
    LIC 9108 SP (3/05) - Statement Adknowledging Requirement To Report Child Abuse
  • 05-077
    QR 29 (5/04) - Applicant Test
  • 05-076
    DFA 287 (3/00) - Food Stamp Program Identification Card
  • 05-075
    WTW 6 English & Spanish (6/99) & WTW 7 English & Spanish (5/99) - Welfare To Work Exemption Request/Welfare To Work Exemption Determination
  • 05-074
    TLR 508 (5/05) - Trustline Registry Criminal Record Statement
  • 05-073
    LIC 9163 (5/05) - Request For Live Scan Service
  • 05-072
    TEMP 2223 English & Spanish (3/05) - Notice To All Quarterly Reporting (QR) Households Not Receiving Cash Aid
  • 05-071
    LIC 9142a (1/05) - Roster Of Participants - For Vendor Use Only
  • 05-070
    LIC 9217 SP (3/05) - Pre-Licensing Readiness Guide - Family Child Care Home
  • 05-069
    GEN 1031 (4/05) - Annual County Training Plan For FY 2005-2006
  • 05-068
    LIC 9163 Spanish (4/05) - Request For Live Scan Service
  • 05-067
    LIC 9011B (5/05) - CDSS Licensing Administrative Action Personnel Flagging Attachment
  • 05-066
    LIC 279 English & Spanish (2/05) - Need Help Completing The Application For A Family Child Care Home License?
  • 05-065
    PUB 275 English & Spanish (4/05) - Family Planning - Making The Commitment For A Healthy Future
  • 05-063
    PUB 337 (1/05) - SFIS Brochure
  • 05-062
    LIC 279A (3/05) - Application Instructions For A Family Child Care Home License
  • 05-061
    LIC 311F (4/05) - Records To Be Maintained At The Facility - Residential Care For The Elderly
  • 05-060E
    Errata to 05-060 - FS 23 QR English & Spanish (3/05) - Food Stamp Bureau - How To Report Household Changes
  • 05-060
    FS 23 QR English & Spanish (3/05) - Food Stamp Bureau - How To Report Household Changes
  • 05-059
    DFA 303 English & Spanish (3/05) - Replacement Affidavit/Authorization (DFA 303)
  • 05-058
    LIC 9149 English & Spanish (2/05) - Property Owner/Landlord Consent Family Child Care Home
  • 05-057
    FS 26 English & Spanish (3/05) - Food Stamp Program Qualifying Drug Felon Addendum
  • 05-056
    LIC 999A English & Spanish (2/05) - Facility Sketch (Floor Plan) - Family Child Care Home
  • 05-055
    LIC 9163 (4/05) - Request For Live Scan Service
  • 05-054
    LIC 311D (3/05) - Forms/Records To Keep In Your Family Child Care Home
  • 05-053
    LIC 9108 (3/05) - Statement Acknowledging Requirement To Report Child Abuse
  • 05-052
    TEMP 2214 English & Spanish (1/05) - Additional Information About Electronic Benefit Transfer (EBT)
  • 05-051
    CCP 7 English & Spanish (3/05) - CalWORKs Stage One Child Care Informing Notice And Request Form
  • 05-050
    LIC 9217 (3/05) - Pre-Licensing Readiness Guide - Family Child Care Home
  • 05-049
    LIC 9151 (3/05) - Property Owner/Landlord Notification - Family Child Care Home
  • 05-048
    LIC 9150 (3/05) - Parent Notification - Additional Children In Care
  • 05-047E
    Errata - CW 2166 English & Spanish (7/02) - Work Really Pays! Here's How
  • 05-047
    CW 2166 (7/02) - Work Really Pays! Here's How
  • 05-046
    CA 800 FC FED PIA (2/05) - Foster Care Placement Information Addendum (PIA) Federal
  • 05-045
    CA 800 FED (2/05) - Summary Report Of Assistance Expenditures, CalWORKs Assistance, CalWORKs Diversion, and KinGAP, Federal
  • 05-044
    LIC 421B (3/05) - Civil Penalty Assessment (Criminal Background Clearance)
  • 05-043
    CW 2197 (7/05) - Timing Out Questionnaire Stage One CalWORKs Child Care
  • 05-042E
    Errata to 05-042 - LIC 421A (3/05) - Civil Penalty Assessment (Unlicensed Facility)
  • 05-042
    LIC 421A (3/05) - Civil Penalty Assessment (Unlicensed Facility)
  • 05-041
    QR 285B (2/05) - Food Stamp Budget Worksheet
  • 05-040
    LIC 9011A (4/05) - County Licensing Administrative Action - Personnel Flagging Attachment
  • 05-039
    Obsolete Forms: DFA 286 English & Spanish; DFA 290 English & Spanish; DFA 293 English & Spanish; DFA 301 English & Spanish; FS 5 English & Spanish & FS 15 English & Spanish
  • 05-038
    DFA 303 English & Spanish (2/05) - Replacement Affidavit/Authorization
  • 05-037
    FC 3 (11/04) - Determination Of Federal AFDC-FC Eligibility
  • 05-036
    PUB 122 English & Spanish (1/04) - Child Care Advocate Program
  • 05-035
    LIC 9218 (2/05) - Application Checklist - Child Care Center
  • 05-034
    LIC 9212 (2/05) - Consumer Awareness Information - Family Child Care
  • 05-033
    TEMP CA 800 ROSALES CERT (2/05) - Rosales v. Thompson Retroactive Payments - Summary By Funding/Certification
  • 05-032
    TEMP CA 800 ROSALES ASST (2/05) - Rosales v. Thompson Retroactive Payments - Assistance
  • 05-031
    FC 2 SP (11/04) - Statement Of Facts Supporting Eligibility For AFDC-Foster Care
  • 05-030
    LIC 9139 (2/05) - Renewal Of Continuing Education Course Approval
  • 05-029
    LIC 604A (2/05) - Admission Agreements For Residential Care Facilities For The Elderly
  • 05-028
    DPA 481 (4/02) - County Report Of Compliance Transmittal
  • 05-027
    DFA 285-A2 English & Spanish (12/04) - Statement Of Facts
  • 05-026
    LIC 701 Spanish (8/01) - Physician's Report - Child Care Centers
  • 05-025
    DFA 285-A1 English & Spanish (12/04) - Food Stamp Benefits
  • 05-024
    FS 26 English & Spanish (1/05) - Food Stamp Program Qualifying Drug Felon Addendum
  • 05-023
    FS 22 QR English & Spanish (12/04) - Applying For Food Stamp Benefits
  • 05-022
    LIC 183 (10/03) - Facility Forms Request - Group Homes; LIC 183A (10/03) - Facility Forms Request - Adult Facilities; LIC 183B (10/03) - Facility Forms Request - Residential Care Facilities For The Elderly; LIC 183C (12/03) - Facility Forms Request - Child Care Centers; LIC 183D (12/03) - Facility Forms Request - Family Child Care Homes; LIC 183E (12/03) - Facility Forms Request - Small Family Homes; LIC 183F (12/03) - Facility Forms Request - Foster Family Homes
  • 05-021
    TEMP CA 800 ROSALES ADMIN (2/05) - Rosales v. Thompson Retroactive Payments - Administrative Costs
  • 05-020
    CA 800M1 (1/05) - CalWORKs Assistance, Recent Non-Citizens, Mixed Cases Case Count Information
  • 05-019
    CA 800L NONFED (1/05) - Summary Report Of Assistance Expenditures, CalWORKs Assistance, Recent Non-Citizens, Nonfederal
  • 05-018
    CA 800A FED (1/05) - Summary Report Of Assistance Expenditures, Adoption Assistance, Emergency Assistance-General Assistance, Emergency Assistance-Foster Care, Refugee Cash Assistance, Federal
  • 05-017
    CA 800 FED (1/05) - Summary Report Of Assistance Expenditures, CalWORKs Assistance, CalWORKs Diversion, and KinGAP, Federal
  • 05-016
    AD 590A SP (1/05) - Waiver Of Right To Further Notice Of Adoption Planning (Presumed Father In Or Out Of California)
  • 05-015
    Various Forms That Are Now Obsolete
  • 05-014
    TLR 301E (12/03) - Trustline Reference Request - Exemption
  • 05-013
    AD 924 (7/02) - Independent Adoption Placement Agreement
  • 05-012
    FS 22 English & Spanish (12/03) - Applying For Food Stamp Benefits
  • 05-011
    FC 2 (11/04) - Statement Of Facts Supporting Eligibility For AFDC-Foster Care (FC)
  • 05-010
    FC 18 (11/04) - Notification Of AFDC-Foster Care Transfer
  • 05-009
    FC 4 (11/04) - Foster Child Program Choice Indicator
  • 05-008
    AD 590A (1/05) - Waiver Of Rights To Further Notice Of Adoption Planning (Presumed Father In Or Out Of California)
  • 05-007
    AD 90 (1/05) - Supporting Information For Issuance Of California Department Of Social Services Acknowledgement And Confirmation Of Receipt Of Relinquishment Documents
  • 05-003
    LIC 9194 SP (9/04) - Live Scan Instructions For State Licensed Facilities
  • 05-002
    LIC 402 SP (8/04) - Surety Bond
  • 05-001
    PUB 269 SP (1/05) - California Child Passenger Safety Law