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