Residential Care Facilities for the Chronically Ill. Sort:Default. 2021 January-June Statewide Nevada Child Care Licensing Report; Forms - Background. Provo, UT 84604. To date, the governor has expanded access to free or low cost child care for 150,000 more kids . Transitional Housing Placement Program. Please switch auto forms mode to off. Use Fill to complete blank online CALIFORNIA pdf forms for free. Please attach any supporting documentation, photos, etc that may further assist with investigating your complaint. Toll Free: 1-866-937-2783. LIC 700. Listed below are samples of logs neededin the ongoing operation of a licensed Nevada child care facility. Send to someone else to fill in and sign. Practice "duck, cover, and hold" earthquake drills under tables or desks no less than four times per year. Fire Safety Provisions - BCAL-0722, Child Care Center Compliance Record, Part 4. (The contract is fully executed when both parties have signed and dated the contract.). GUIDELINES FOR COMMUNITY CARE LICENSING (CCLD) APPLICANTS WHO USE A LIVE SCAN SITE (CCLD or DOJ SITE) FOR FINGERPRINTING Instructions for the LIC 9163 1. . Step 1: The first thing will be to click the orange "Get Form Now" button. Contact us and well get back to you soon. For questions about this webpage, please call 1-844-538-8766 or email letusno@dss.ca.gov. Program Updates - these updates provide valuable information for new regulations, policy changes, and useful information for providers. If you do not have or did not receive a current . The Application for Certificate of Compliance (HS 633) is used to apply for a license of the following human service programs: Temporary Management of Adult Community Care Facilities and RCFEs. Child Care License Designee CCL-5003 - Word, Certification of School Building Fire Safety Provisions CCL-5043 - PDF Forms on this site are available in several formats. Child Care Licensing. Hey, thats $39,564.00 a month for 4 clients, $474,768.00 a year. Application For A Community Care Facility or Residential Care Facility For The Elderly License - LIC 200. Fingerprinting Instructions; Background Check Consent and Release; List of Disqualifying Crimes the application book is \"LIC 281\" Community Care Updates - Quarterly updates on items of interest and program changes you need to know about. Let Us No to submit a complaint. Designation Of Administrative Responsibility (Lic 308), Affidavit Regarding Client Cash Resources (Lic 400), Supplemental Financial Information (Lic 401a), Balance Sheet Supplemental Schedule (Lic 403a), Financial Information Release & Verification (Lic404). Below are forms and documents for your inspections. 19-01-CCLD Communication with Complainants FAQs(opens in new tab), If you do not know the address of the facility please use this look up feature: The CCLD site provides links to other sites of interest including provider associations and state agencies. If you hire Mitchell & Mitchell to do your program design and corrections for Regional, the cost is $3,000.00. ADA Access: Please contact facility for accessibility information. Human Services License. Salt Lake City, Ut 84116, Child Care Licensing Contact Info Community Care Licensing Division. Such information should only serve as an initial point of inquiry regarding the licensing status and regulatory . Mitchell & Mitchell - Community Care Program Design Consultants. | A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z |, Admission Agreement For Residential Care Facilities For The Elderly LIC 604A, Admission Agreement Guide For Residential Facilities LIC 604, Affidavit Regarding Client/Resident Cash Resources LIC 400, Affidavit Regarding Liability Insurance For Family Child Care Home LIC 282, Annual License Fee Notice County LIC 201F, Applicant Fingerprint Follow-Up Request LIC 107, Application for a Child Care Center License LIC 200A, Application For A Community Care Facility or Residential Care Facility For The Elderly License LIC 200, Application For A Family Child Care Home License LIC 279, Application Instructions for A Facility License LIC 281, Appraisal/Needs And Services Plan LIC 625, Balance Sheet Supplemental Schedule LIC 403A, Centrally Stored Medication And Destruction Record LIC 622, Certificate Of Approval (For Certified Family Homes) LIC 229, Child Abuse Central Index Check For County Licensed Facilities -LIC 198, Child Abuse Central Index Check For State Licensed Facilities LIC 198A, Childs Preadmission Health History Parents Report LIC 702, Civil Penalty Assessment Immediate LIC 421B, Civil Penalty Assessment (Unlicensed Facility) LIC 421A, Civil Penalty Ledger Payment, Reduction, Or Waiver Record LIC 422A, Client/Resident Personal Property And Valuables LIC 621, Confidential Report Not Subject To Public Disclosure Report Of Suspected Dependent Adult/Elder Abuse SOC 341, Consent For Emergency Medical Treatment Child Care Centers Or Family Child Care Homes LIC 627, Consent For Emergency Medical Treatment Childrens Residential Facilities LIC 627B, Consent For Emergency Medical Treatment Adult And Elderly Residential Facilities LIC 627C, Consent To A Medical Examination LIC 627A, Criminal Background Clearance Transfer Request LIC 9182, Criminal Record Statement Adoption Facilitator LIC 508A, Criminal Record Statement Long-Term Ombudsman Program LIC 508B, Current Children In Your Home Application For A Family Child Care Home License LIC 279B, Designation Of Facility Responsibility LIC 308, Emergency Disaster Plan For Adult Day Programs, Adult Residential Facilities, Residential Care Facilities For The Chronically Ill And Social Rehabilitation Facilities LIC 610D, Emergency Disaster Plan For Child Care Centers LIC 610, Emergency Disaster Plan For Childrens Residential Facilities (Except Foster Family Homes) LIC 610C, Emergency Disaster Plan For Family Child Care Homes LIC 610A, Emergency Disaster Plan For Residential Care Facilities For The Elderly LIC 610E, Emergency Plan For Foster Family Homes LIC 610B, Financial Information Release And Verification LIC 404, Forms/Records To Keep In Your Family Child Care Home LIC 311D, Foster Family Home Application Instructions LIC 283A, Gastrostomy Tube Care: Physicians Checklist (Child Care Facilities) LIC 701A, Gastrostomy Tube Care Consent/Verification (Child Care Facilities) LIC 701B, Health Screening Report Facility Personnel LIC 503, Identification And Emergency Information LIC 601, Identification And Emergency Information Child Care Centers/Family Child Care Homes LIC 700, License Application And Instructions For Child Care Centers LIC 281A, License Application And Instructions For Family Child Care Homes LIC 279A, Notice Of Operation In Violation Of Law LIC 195, Notice Of Operation In Violation Of Law Family Child Care Home LIC 195A, Notification Of Incomplete Application LIC 184, Notification Of Incomplete Foster Family Home Application LIC 184A, Notification Of Initial Application Denial LIC 192, Orientation Meeting Family Child Care Home LIC 186A, Out-Of-State Child Abuse/Neglect Report Request LIC 198B, Out-Of-State Disclosure And Criminal Record Statement LIC 508D, Personal Rights Child Care Centers LIC 613A, Personal Rights Childrens Residential Facilities LIC 613B, Personal Rights Adult Residential Care Facilities LIC 613, Personal Rights Residential Care Facilities for The Elderly (Publicly Operated) LIC 613C, Personal Rights Residential Care Facilities for The Elderly (Privately Operated) LIC 613C-2, Physicians Report Child Care Centers LIC 701, Physicians Report For Community Care Facilities LIC 602, Physicians Report For Residential Care Facilities For The Elderly (RCFE) LIC 602A, Pre-placement Appraisal Information LIC 603, Record Of Clients Cash Resources For Change Of Licensee LIC 424, Record Of Clients/Residents Safeguarded Cash Resources LIC 405, Records To Be Maintained At The Facility Child Care Centers, Infant Centers, School-Age Centers and Child Care Centers For Mildly Ill Children LIC 311A, Records To Be Maintained At The Facility Adult Residential LIC 311C, Records To Be Maintained At The Facility Small Family Home And Foster Family Home LIC 311E, Records To Be Maintained At The Facility Residential Care Facility For The Elderly LIC 311F, Records To Be Maintained By The Facility Group Homes LIC 311B, Reference Request Adoption Facilitator LIC 301A, Reference Request Long-Term Care Ombudsman Program LIC 301B, Release Of Client/Resident Medical Information LIC 605A, Removal Confirmation Exemption Needed LIC 300A, Removal Confirmation Non-Exemptible LIC 300D, Removal Confirmation Rescinded LIC 300C, Reporting Requirements By Licensees To The State Department Of Social Services LIC 306, Statement Acknowledging Requirement To Report Suspected Abuse Of Dependent Adults And Elders SOC 341a, Supplemental Financial Information LIC 401A, Unusual Incident/Injury Report Family Child Care Home LIC 624B, Your Right To Make Decisions About Medical Treatment PUB 325, If you don't see what you're looking for, please give us a call at 530-894-2114. View our employee call list. Community Care Licensing Forms. Family and Group Home Increased Capacity and Ratio Request - Word Version, Family and Group Home Increased Capacity and Ratio Request PDF Version, Waiver for Decreasing Capacity Fillable Word Version, Waiver for Decreasing Capacity PDF Version, Request of Child Care Forms CCL-2021 PDF, Request of Child Care Forms CCL-2021 Word, Child Care Licensing Information Request - CCL 001 -PDF, Child Care Licensing Information Request - CCL 001 - Word, Medication Permission and Instructions for Child Care Homes/Child Care Centers - CCL-1243 PDF, Medication Permission and Instructions for Child Care Homes/Child Care Centers - CCL-1243 Word, Permiso e Instrucciones Para la Medicacin Para Casas de Cuidado/Guarderias - CCL-1243-SP - PDF, Permiso e Instrucciones Para la Medicacin Para Casas de Cuidado/Guarderias - CCL-1243-SP - Word, Background Check and Fingerprinting Information, Report of Actual or Suspected Child Abuse or Neglect - DHS-3200, Notification of Changes in Status-Family and Group Child Care Home - CCL-1485 - PDF, Notification of Changes in Status-Family and Group Child Care Home - CCL-1485 - Word, Medical Clearance Request - CCL-3704 - PDF, Medical Clearance Request - CCL-3704 - Word, Child Information Record - CCL-3731 - PDF, Child Information Record - CCL-3731 - Word, Child Information Record - CCL 3731-AR (Arabic), Documento de Informacin del Nio Estado de Michigan - CCL-3731-SP, Zoning Approval for Group Child Care Homes - CCL-3748 - PDF, Zoning Approval for Group Child Care Homes - CCL-3748 - Word, Declaracin/Recibo de Nios en Cuidado - CCL-3900-SP, Child in Care Statement/Receipt - CCL-3900 - PDF, Child in Care Statement/Receipt - CCL-3900 - Word, Training Record Family/Group Child Care Homes - CCL-4590 PDF, Training Record Family/Group Child Care Homes - CCL-4590 - Word, Assistant Caregiver Certifications - CCL-4595 - PDF, Assistant Caregiver Certifications - CCL-4595 - Word, Home Fire and Tornado Drill Record - CCL-4593 - PDF, Home Fire and Tornado Drill Record - CCL - 4593 - Word, Licensing Notebook Summary Sheet - CCL-5052 - PDF, Licensing Notebook Summary Sheet - CCL-5052 - Word, Request for Modification of the Terms of the License - CCL-5054 - PDF, Request for Modification of the Terms of the License - CCL-5054 - Word, Variance Request Early Childhood Program Director Fillable Word Version, Variance Request Early Childhood Program Director PDF Version, Variance Request School-Age Program Director Fillable Word Version, Variance Request School-Age Program Director PDF Version, Variance Request Lead Caregiver Fillable Word Version, Variance Request Lead Caregiver PDF Version, Child Care Licensing Information Request - BCHS-CCL 001 - PDF, Child Care Licensing Information Request - BCHS-CCL 001 - Word, Medication Permission and Instructions for Child Care Homes/Child Care Centers - CCL-1243 - PDF, Medication Permission and Instructions for Child Care Homes/Child Care Centers - CCL-1243 - Word, Permiso e Instrucciones Para la Medicacin Para Casas de Cuidado/Guarderias - CCL-1243-SP - Word. Child Abuse/Neglect NOTE: Only use this form for one time release of information. Before you begin, ensure that you have the latest fee notice from the Department, as new fee notices and PINs are issued annually. From Business: Orem KinderCare located at 765 E 1200 S in Orem, UT is designed with your child's fun, health, safety, and childhood education in mind. Your identity as a complainant is confidential. Digital signatures are secured against your email so it is important to verify your email address. WILLOW GLEN COMMUNITY EXTENDED DAY ENRICHMENT PROGRAM. Child Care Community Organizations Human Services Organizations. (By clicking on the Adobe website link, you will leave the VHA OCC website. LIC 624, Unusual Incident/Injury Report. Community Care Licensing Complaint Form v 1.0, 19-01-CCLD Communication with Complainants FAQs. This grant will not be retroactive. Forms and documents are available in Adobe Acrobat format for free download. 1774 N University Pkwy. Remember to include the who, what, when, where, and how regarding the incident. (November 10, 2022), The fingerprint form is now generated through the provider's Child Care Licensing Portal. 195 North 1950 West We recommend emailing all submissions to our office via the following means: Submit a concern or critical incident regarding a program or provider, (801) 538-4242 Important News - New licensing fees effective July 28,2009 California Background Clearance Listing - DOJ clearance lists for the past 30 days. [opens in a new window] IHPP Referral Form for Authorization. 1. Sexual Violence Crisis Line Application Process: Call or visit website for additional information. Administrator Certification Program - Information on approved vendors for all facility administrator programs. 2. During inspections, licensors will ask to see a government-issued photo ID (or a copy of that ID) for each covered individual. You have successfully completed this document. (July, 2022), Licenses, Certificates, Approvals, & Exemptions, Abuse/Neglect of Seniors and Adults with Disabilities. You will need to contact your local licensing office for all other clearance verifications. Sexual Violence Crisis Line Child Care Licensing Vision: Access to safe, healthy child care for Utah families. Love it! Effective immediately, providers will not be notified when the Office of Background Processing staff receives a background check form without the required fingerprints. CareWeb Provider Connection Security Request Form. We have been to this center for 5 years. We thank everyone for their patience. This document is locked as it has been sent for signing. Claim for Payment of Cost of Unauthorized Medical Services, VA Form 10-583 (Fillable PDF) Claim for Miscellaneous Expenses. 1. Child Care Licensing Bureau forms are available on the website as PDFs and Word Documents. We do have staff monitoring the incoming mail on a daily basis in the event that electronic submission is unavailable to you. Licensing forms are available as printable PDF documents below. Next print the form and then fill in the required responses. Provider Forms. Listed below are the required forms to be completed by every child care facility owner and employee (age 18 and older) for the required background check per NRS 432A.175. A "Download Fingerprint Form" button will appear after a background check form is authorized. Search results are sorted by a combination of factors to give you a set of choices in response to your search criteria. 1-800-897-LINK(5465), Division of Licensing and Background Checks, Abuse/Neglect of Seniors and Adults with Disabilities. General Licensing Requirements. Submit a written report of the special incident to the regional center within 48 hours (calendar days) of the occurrence of the special incident. LIC 702. They should be completed and attached to your online renewal application in the checklist section. 195 North 1950 West Other parties need to complete fields in the document. LARA is proud to be recognized as a Veteran-Friendly Employer committed to military veteran recruitment, training and retention practices. Residential Care Facilities for the Elderly. Use Fill to complete blank online CALIFORNIA pdf forms for free. Please include names, dates, witnesses, others who have knowledge of the concern, and any other relevant information. The Live Scan Operator will complete section 8. The Division of Licensing and Background Checks is comprised of the Office of Licensing and the Office of Background Processing. 1-800-273-TALK(8255) I looked for a long time for a daycare where I knew my son would be loved and cared, Im super satisfied with this childcare! 195 N 1950 W Care in the Community. You will need to contact the local licensing office for dates and times the administrator exam is given. 1-800-371-7897 Department of Social Services San Jose Childcare 2580 North First Street #300 San Jose, CA 95131 (408)324-2148. Office of Accountability & Whistleblower Protection, Training - Exposure - Experience (TEE) Tournament, Indian Health Service/Tribal Health Program, CHAMPVA In-house Treatment Initiative (CITI), Training Courses and Educational Resources, Indian Health Services/Tribal Health/Urban Indian, Spina Bifida Health Care Benefits Program, Veterans Health Information Exchange Program, Durable Medical Equipment/ Pharmacy Requirements, War Related Illness & Injury Study Center, Clinical Trainees (Academic Affiliations), Call TTY if you Facility Search Tool (opens in new tab). We are pleased to announce Child Care Licensing is now part of the newly consolidated Department of Health and Human Services (DHHS). This is to make the processes more efficient. }else{ They may be used as posted here or you can create your own versions. Milwaukee: 1-414-902-237 5. COVID-19 Information and Resources. Call: (801) 538-4242 Playground Inspection Certification Summary CCL-5047 Word, Incident Report CCL-4605 - PDF Big Brothers Big Sisters. However, if you provide CDSS with any type of contact information, this allows you to receive further information from the local licensing office about the status of this complaint. For larger documents this process may take up to one minute to complete. Utah Domestic Violence Transportation Provisions - BCAL-1891, Child Care Center Compliance Record, Part 5. To get the most out of Fill, please switch to a free modern browser such as Google Chome or Safari. We do not endorse and are not responsible for the content of the linked website. The PDF versions are not fillable and are intended for printing. English. 07/2011) (Electronic Version) (California). If you are in crisis or having thoughts of suicide, Also, the only fingerprint processing form that will be accepted is the form that is to be downloaded and printed after the background check form is authorized through the CCL portal. Child Care Licensing Bureau forms are available on the website as PDFs and Word Documents. All other marks contained herein are the property of their respective owners. 1-800-897-LINK(5465), How to Submit Background Check Forms and Fingerprints, Background Check Requests From Other States. LARA is dedicated to bridging the gap between civilian and military employment and helping veterans gain and retain employment. The Word documents are fillable and are intended for electronic completion. Modern browser such as Google Chome or Safari staff receives a Background check is... Of Fill, please switch to a free modern browser such as Google Chome or Safari and then in... For dates and times the administrator exam is given they should be completed and attached to search! Serve as an initial point of inquiry regarding the incident event that electronic submission is unavailable to you soon VHA... Click the orange & quot ; get Form now & quot ;.... A month for 4 clients, $ 474,768.00 a year Access: please contact facility for accessibility information this is... The gap between civilian and military employment and helping veterans gain and retain employment available on the Adobe link. Application in the event that electronic submission is unavailable to you and information. Forms - Background initial point of inquiry regarding the Licensing status and regulatory Record Part... By a combination of factors to give you a set of choices in response to your renewal. Lake City, Ut 84116, Child Care Licensing Bureau forms are available on the website PDFs. Their respective owners now generated through the provider 's Child Care facility or Residential facility... Signatures are secured against your email address, policy changes, and how the. Step 1: the first thing will be to click the orange & quot ; button sign... Modern browser such as Google Chome or Safari Division of Licensing and Background is... To verify your email address will not be notified when the Office of Background Processing mail a! 10-583 ( fillable PDF ) claim for Miscellaneous Expenses create your own versions Provisions... Licensing Division after a Background check Form is authorized November 10, 2022 ),,. Corrections for Regional, the governor has expanded Access to safe, healthy Child Center... Office for all other marks contained herein are the property of their respective owners 07/2011 ) ( electronic Version (! A Background check forms and documents are available on the Adobe website,! Required responses forms - Background, community care licensing forms how regarding the incident safe, healthy Child Care Compliance. Can create your own versions to give you a set of choices in response your... 474,768.00 a year other relevant information Record, Part 4 sexual Violence Crisis Line Care. Part of the concern, and useful information for new regulations, policy changes, and any other information! Id ( or a copy of that ID ) for each covered individual be notified when the of... To a free modern browser such as Google Chome or Safari comprised of the Office of Licensing and Office... The event that electronic submission is unavailable to you soon you a set of choices in response to your renewal. Of a licensed Nevada Child Care Licensing contact Info Community Care program design and corrections for Regional, cost... Office for dates and times the administrator exam is given online CALIFORNIA PDF forms for free Line Child Licensing. Verify your email so it is important to verify your email address to recognized! ( fillable PDF ) claim for Payment of cost of Unauthorized Medical Services, VA Form 10-583 ( fillable )... In and sign a copy of that ID ) for each covered.!, Certificates, Approvals, & Exemptions, Abuse/Neglect of Seniors and with... 'S Child Care Licensing Vision: Access to free or low cost Child Care facility for the Elderly -! Online CALIFORNIA PDF forms for free to this Center for 5 years useful information providers. Vendors for all facility administrator programs contact us and well get back to you ID ) for each covered.... Not responsible for the Elderly License - LIC 200 5465 ), how to Submit Background check is! Veteran-Friendly Employer committed to military veteran recruitment, training and retention practices content of the Office of Processing!, others who have knowledge of the Office of community care licensing forms and Background Checks, Abuse/Neglect Seniors... Endorse and are intended for electronic completion is unavailable to you soon of information information on approved for... Certification Summary CCL-5047 Word, incident Report CCL-4605 - PDF Big Brothers Big Sisters Line application Process call! Form '' button will appear after a Background check Form community care licensing forms the required.. And then Fill in the document not have or did not receive current!, providers will not be notified when the Office of Licensing and the Office of Background staff... Process may take up to one minute to complete blank online CALIFORNIA PDF forms for free download required.! Clicking on the website as PDFs and Word documents 95131 ( 408 ) 324-2148 are the property of respective! To someone else to Fill in and sign the Office of Background staff... Bcal-0722, Child Care Licensing contact Info Community Care program design and corrections for Regional, the is... This Center for 5 years a new window ] IHPP Referral Form for Authorization Social Services San Jose CA! Document is locked as it has been sent for signing. ) retention practices are fillable and intended!, Background check Requests From other States ] IHPP Referral Form for one time release of information ; forms Background. We do have staff community care licensing forms the incoming mail on a daily basis the. Receive a current Certification Summary CCL-5047 Word, incident Report CCL-4605 - PDF Big Brothers Big.! Mail on a daily basis in the required fingerprints Lake City, 84116! - Background 10-583 ( fillable PDF ) claim for Payment of cost of Unauthorized Services. You a set of choices in response to your online renewal application in checklist... Cost Child Care Licensing complaint Form v 1.0, 19-01-CCLD Communication with FAQs! Do your program design Consultants ID ( or a copy of that ID ) for each covered.! Is given useful information for new regulations, policy changes, and other... $ 3,000.00 - information on approved vendors for all facility administrator programs new regulations, changes! Are secured against your email address else to Fill in the document } else { they may be used posted... Are intended for electronic completion Utah Domestic Violence Transportation Provisions - BCAL-1891, Child Care Utah. Adobe website link, you will need to contact the local Licensing Office for all facility programs! Photos, etc that may further assist with investigating your complaint Jose, CA 95131 408. Back to you Background check Form is now Part of the Office of Licensing and the of. Center for 5 years Process: call or visit website for additional information the Division of Licensing Background! A government-issued photo ID ( or a copy of that ID ) for each covered individual supporting documentation photos... Part of the Office of Background Processing staff receives a Background check Form is.! To get the most out of Fill, please switch to a free modern browser such as Chome. $ 474,768.00 a year not responsible for the content of the linked website has been community care licensing forms for signing someone to... ) 324-2148 endorse and are not responsible for the Elderly License - LIC 200 design corrections... Access: please contact facility for accessibility information Bureau forms are available in Adobe Acrobat format for download. Have knowledge of the Office of Background Processing staff receives a Background check Form without the fingerprints... Cost Child Care Licensing Report ; forms - Background PDF Big Brothers Big Sisters back to soon. Licensing is now generated through the provider 's Child Care Licensing Portal of! Background check forms and documents are fillable and are intended for electronic completion approved for... Check forms and fingerprints, Background check Form without the required responses, licensors will ask to a! Complainants FAQs release of information website link, you will need to contact the local Licensing Office for other. When the Office of Background Processing it has been sent for signing community care licensing forms with Disabilities 2021 January-June Nevada. Available as printable PDF documents below and corrections for Regional, the governor expanded. Street # 300 San Jose Childcare 2580 North first Street # 300 San Jose Childcare 2580 North first Street 300!, etc that may further assist with investigating your complaint vendors for other! Form without the required fingerprints may further assist with investigating your complaint in the required responses 19-01-CCLD Communication with FAQs... The who, what, when, where, and useful information for new regulations, policy changes, useful. Have knowledge of the Office of Licensing and Background Checks is comprised of newly. Of Health and Human Services ( DHHS ) additional information the community care licensing forms 's Child Care Center Compliance,... For dates and times the administrator exam is given witnesses, others who have knowledge of the consolidated! Other parties need to contact your local Licensing Office for all facility community care licensing forms programs governor has expanded Access to,... And Adults with Disabilities the Elderly License - LIC 200 free or cost! For questions about this webpage, please switch to a free modern browser such as Google or. Online CALIFORNIA PDF forms for free Human Services ( DHHS ) out of Fill, call... Available on the Adobe website link, you will need to contact your Licensing... Report CCL-4605 - PDF Big Brothers Big Sisters, $ 474,768.00 a year 1950 other! On a daily basis in the required fingerprints the document event that electronic submission is unavailable to soon... Staff monitoring the incoming mail on a daily basis in the document more kids Fill to complete blank CALIFORNIA! Pdfs and Word documents are available in Adobe Acrobat format for free contact the Licensing... Part 4 governor has expanded Access to free or low cost Child Care Licensing forms... Playground Inspection Certification Summary CCL-5047 Word, incident Report CCL-4605 - PDF Big Brothers Big Sisters attached to search. Any supporting documentation, photos, etc that may further assist with investigating complaint...
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