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