Final decisions have not yet been made and contacting CCL staff may delay that decision making process. Child Care Licensing Program Office 744 P Street, MS: T9-15-48 Sacramento, CA 95814 Phone (916) 651-6040 Fax (916) 651-0531 Northern Regional Offices Assistant Program Administrator, Robert Garza (916) 651-6040, Alt. Licensing & Providers. This form can be submitted anonymously. Crisis Line & Mobile Outreach Team Title 22 Regulations - Sorted by Facility Type Online Evaluator Manual - Procedures manual and Regulation Interpretation. Headquarters Child Care Licensing Bureau forms are available on the website as PDFs and Word Documents. You will need to contact your local licensing office for all other clearance verifications. During inspections, licensors will ask to see a government-issued photo ID (or a copy of that ID) for each covered individual. (July, 2022), Licenses, Certificates, Approvals, & Exemptions, Abuse/Neglect of Seniors and Adults with Disabilities. A physical address must be provided to investigate your concerns. Claim for Miscellaneous Expenses, VA Form 10-7959e (Fillable PDF) NOTE: This form is not for provider use. Toll Free: 1-866-937-2783. Reducing Barriers to Licensure for Military Families, Corporations, Securities & Commercial Licensing, Find / Verify a Licensed Professional or Business, Make a Complaint About a Licensed Professional or Business, Look Up Underground Storage Tank Information, Access the Online Liquor Ordering (OLO) System, Regulated Products, Professions, & Businesses Activities, Resources for Veterans & Military Families, https://dev.michigan.local/som/json?sc_device=json, Playground Inspection Certification Summary CCL-5047 Word, Go to An Online Resource for Skilled Immigrants, Medical Marijuana Program (MMMP) Patients & Caregivers, Learn About CRA Rules, Laws & Regulations, Find / Verify a CRA Licensed Professional or Business, Make a Complaint About a CRA Licensed Professional or Business, Track Marijuana Inventory - Statewide Marijuana Monitoring System (Metrc), Find Panel, Public Hearing & Workgroup Information, Find a Disciplinary Action Report or Document, Learn About CCL Rules, Laws & Regulations, Find / Verify a CCL Licensed Professional or Business, Make a Complaint About a CCL Licensed Professional or Business, Apply for / Renew a BCC License or Permit, Find / Verify a BCC Licensed Professional or Business, Make a Complaint About a BCC Licensed Professional or Business, Learn About Examinations & Continuing Education, Find / Verify a BCHS Licensed Professional or Business, Make a Complaint About a BCHS Licensed Professional or Business, Go to Corporations, Securities & Commercial Licensing, Find / Verify a CSCL Licensed Professional or Business, Make a Complaint About a CSCL Licensed Professional or Business, Contact the Michigan Liquor Control Commission, Local Government & Law Enforcement Resources, Go to Michigan Office of Administrative Hearings and Rules, Administrative Hearings Frequently Asked Questions, Request to Attend a Hearing (for Media Professionals), Go to Michigan Indigent Defense Commission, Learn About Continuing Legal Education (CLE), Make a Complaint or Inquiry About a Utility Provider, Compare Natural Gas Utilities Options (MI Gas Choice), Submit an Underground Utilities Locate Request (MISS DIG 811), Learn About Natural Gas & Pipeline Providers, Learn About Rules of Practice and Procedure, Find / Verify a BPL Licensed Professional or Business, Make a Complaint About a BPL Licensed Professional or Business, Michigan Automated Prescription System (MAPS), Find / Verify a UCC Licensed Professional or Business, Make a Complaint About a UCC Licensed Professional or Business, Go to Apply for / Renew a License or Permit, Go to Find / Verify a Licensed Professional or Business, Go to Make a Complaint About a Licensed Professional or Business, Go to Look Up Underground Storage Tank Information, Go to Look Up a Controlled Substance (MAPS), Go to Access the Online Liquor Ordering (OLO) System, Go to Look Up a Disciplinary Action Report, Go to Submit a Request for Information (FOIA), Go to Regulated Products, Professions, & Businesses Activities, Go to Requesting Information from LARA (FOIA), Go to Resources for Veterans & Military Families, Report of Actual or Suspected Child Abuse or Neglect - DHS-3200 - Spanish, Report of Actual or Suspected Child Abuse or Neglect - DHS-3200 - Arabic, Michigan Child Care and Education Professional Development Record for Child Care Centers CCL-4591 - PDF, Michigan Child Care and Education Professional Development Record for Child Care Centers CCL-4591 - Word, Staffing Plan: Child Care Center CCL-5001 - PDF, Staffing Plan: Child Care Center CCL-5001 - Word, Staffing Plan: Child Care Center CCL-5001 Excel, Child Care License Designee CCL-5003 - PDF, Child Care License Designee CCL-5003 - Word, Certification of School Building Fire Safety Provisions CCL-5043 - PDF, Certification of School Building Fire Safety Provisions CCL-5043 - Word, Self-Certification of Transportation Provisions for Centers CCL-5044 - PDF, Self-Certification of Transportation Provisions for Centers CCL-5044 - Word, Volunteer Certification for Field Trip Transportation CCL-5046 - PDF, Volunteer Certification for Field Trip Transportation CCL-5046 - Word, Playground Inspection Certification Summary CCL-5047 - PDF, Family and Group Child Care Home Compliance Record - BCAL-4601, Preparing for Your License Renewal Fire Safety Inspection - BCAL-5048, Child Care Center Compliance Record, Part 1. Once completed you can sign your fillable form or send for signing. Please use this form when submitting SIRs to SDRC and Community Care Licensing. Please call with any questions or to connect with a Licensing staff member. The Community Care Licensing Division of the California Department of Social Services has provided this document search application to provide the public with access to information regarding facilities licensed by the Division. CCL Mission: To support the child care community by protecting the health and safety of children in child care programs we oversee. Facility Search Tool (opens in new tab). We received a lot of applications for the 2022 Compliance Grant and hope to have notifications out by the end of September. 2. (By clicking on the Adobe website link, you will leave the VHA OCC website. We do not endorse and are not responsible for the content of the linked website. For every single segment, fill out the content requested by the software. Corporations, Securities & Commercial Licensing Bureau. You will now be able to tab or arrow up or down through the submenu options to access/activate the submenu links. To access the menus on this page please perform the following steps. ), Veterans Crisis Line: 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. This form can be submitted anonymously. have hearing loss. Application For A Community Care Facility or Residential Care Facility For The Elderly License - LIC 200. This is accomplished by: Establishing, monitoring, and assessing health and safety standards; Fingerprinting Instructions; Background Check Consent and Release; List of Disqualifying Crimes The Division of Licensing and Background Checks is comprised of the Office of Licensing and the Office of Background Processing. Care in the Community. One copy will be retained by the Operator and the other you may retain . Transitional Housing Placement Program. IMPORTANT: You must have Adobe Reader version 6.0 or later installed on your computer to view the documents on this site. This document is locked as it has been sent for signing. Forms and documents are available in Adobe Acrobat format for free download. You will need to contact the local licensing office for dates and times the administrator exam is given. : DIRECT DEPOSIT CALIFORNIA To (California), FACILITY SKETCH (Floor Plan) - Family Child Care (California), UNEMPLOYMENT INSURANCE APPLICATION (Federal Employee) (California), State of California Department of Insurance Live Scan (California), WG-012 SUPERIOR COURT OF CALIFORNIA, COUNTY OF (California), Retirement Allowance Estimate Request (California), ATTACHMENT TO PROOF OF ELECTRONIC SERVICE (PERSONS SERVED) (California), Form 2: FW-002 Request to Waive Additional Court (California), POS-050/EFS-050 SUPERIOR COURT OF CALIFORNIA, COUNTY OF (California), form to sign prior to submittal. Topics of interest: Search for a Facility - This feature assists you in locating licensed facilites throughout California Licensing Forms - Licensing Forms generally begin with \"LIC\". Child Abuse/Neglect This is to make the processes more efficient. Licensing Forms - Licensing Forms generally begin with "LIC". These factors are similar to those you might use to determine which business to select from a local Yellow Pages directory, including proximity to where you are searching, expertise in the specific services or products you need, and comprehensive business information to help evaluate a business's suitability for you. The Office of Background Processing staff will wait 20 working days and, if they don't receive fingerprints within that time, they will cancel the background check form. Eligibility Requirements: Applicants must be 18 years and older. The required forms are part of rule and cannot be changed. Please include names, dates, witnesses, others who have knowledge of the concern, and any other relevant information. Great with the children, beautiful and clean home, and home cooked meals! [opens in a new window] Referral Form for Clinical Trials. LARA is dedicated to bridging the gap between civilian and military employment and helping veterans gain and retain employment. We do have staff monitoring the incoming mail on a daily basis in the event that electronic submission is unavailable to you. Community Care, Inc. - Provider Services1801 Dolphin Drive, Waukesha, WI 53186. LIC 613A. 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: Child Care Licensing Vision: Access to safe, healthy child care for Utah families. The Special Incident Form is to be used by SDRC service providers as well as long-term care facilities. Select option 1 for Claims and Eligibility. This manual is used to interpret and apply regulations The CCLD site provides links to other sites of interest including provider associations and state agencies. Other forms are blank, printable forms which need to be completed offline and mailed. Salt Lake City, UT 84116, Headquarters Contact us and well get back to you soon. Preferred listings, or those with featured website buttons, indicate YP advertisers who directly provide information about their businesses to help consumers make more informed buying decisions. Hey, thats $39,564.00 a month for 4 clients, $474,768.00 a year. Forms. LARA is proud to be recognized as a Veteran-Friendly Employer committed to military veteran recruitment, training and retention practices. Child Care Community Organizations Human Services Organizations. YP advertisers receive higher placement in the default ordering of search results and may appear in sponsored listings on the top, side, or bottom of the search results page. We additionally have phone coverage during weekday business hours at 801-538-4242. Providers who are awarded a grant may receive an email from a State of Utah employee requesting they complete a registration in PaymentWorks. LIC 702. Practice "duck, cover, and hold" earthquake drills under tables or desks no less than four times per year. Big Brothers Big Sisters. Caring for Mi Future is a $100 million strategy to open 1,000 new child care programs by the end of 2024. You're on your way to completing your first doc! 195 N 1950 W Sexual Violence Crisis Line Have questions about licensing and vendorization or about the program designs? (To attach multiple files, click the first file and then hold the control key down and click on any additional files.). Once completed you can sign your fillable form or send for signing. Step 2: Once you have entered the editing page lic 500 community care licensing, you will be able to notice every one of the options available for your file at the upper menu. 2021 January-June Statewide Nevada Child Care Licensing Report; Forms - Background. The Community Care Licensing (California) form is 1 page long and contains: Fill has a huge library of thousands of forms all set up to be filled in easily and signed. Title 22 Regulations - Sorted by Facility Type; Online Evaluator Manual - Procedures manual and Regulation Interpretation . Upload your own documents or access the thousands in our library. Take two copies of this form with you the day you are fingerprinted. However, if you provide CDSS with any type of contact information, Community Care Licensing Forms. The Inspection Checklists are the ones used by licensors . This is one piece of a historic $1.4 billion investment to expand access to quality, affordable child care for families. Community Care Licensing in Provo, UT. National Suicide Prevention Lifeline 1-800-371-7897 Unless you specifically request otherwise, neither the substance of the complaint provided to the licensee, Milwaukee: 1-414-902-237 5. Step 1: The first thing will be to click the orange "Get Form Now" button. Child Abuse/Neglect Our mailing address is: Office of Licensing For additional information, please contact your California Child Care Licensing Program Regional Office. Utah Domestic Violence Volunteer Certification for Field Trip Transportation CCL-5046 - Word, Playground Inspection Certification Summary CCL-5047 - PDF Application for a Child Care Center License - LIC 200A. 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 The Community Care Licensing (California) form is 1 page long and contains: Country of origin: US All program designs are in full compliance with HCBS final Rule. Remember to include the who, what, when, where, and how regarding the incident. All forms are printable and downloadable. Crisis Line & Mobile Outreach Team Application for Child Care Plan Review (BCHS-FS-13), Child Care Center Notice of Arraignment or Conviction CCL-1486 - PDF, Child Care Center Notice of Arraignment or Conviction CCL-1486 - Word, Child Information Record - CCL-3731 Web Proected, Child Information Record - BCAL 3731-AR (Arabic), Documento de Informacin del Nio Estado de Michigan - BCAL-3731-SP, Written Information Packet Documentation CCL-4340 - PDF, Written Information Packet Documentation CCL-4340 - Word, Change of Use Space Request for School-Age Programs Located in Schools CCL-4342 - PDF, Change of Use Space Request for School-Age Programs Located in Schools CCL-4342 - Word, Lead Hazard Risk Assessment Summary CCL-4344 - PDF, Lead Hazard Risk Assessment Summary CCL-4344 - Word, No Change in Building Construction Declaration CCL-2129 - PDF, No Change in Building Construction Declaration CCL-2129 - Word, Infant/Toddler Primary Caregiver Documentation CCL-4557 - PDF, Infant/Toddler Primary Caregiver Documentation CCL-4557 - Word, Center Fire and Tornado Drill Record - CCL-4593 - PDF, Center Fire and Tornado Drill Record - CCL-4593 - Word, Staffing Plan: Child Care Center CCL-5001 - PDF 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. 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. . or certified family home or resource family and foster family agency, nor any copy of the complaint or any record published, Group Homes. (January 30, 2023), Take a minute to watch a tour of the website by clicking here: Childcarelicensing.utah.gov, Tome un minuto para ver una presentacin de nuestro sitio web haciendo clic aqu: Childcarelicensing.utah.gov. 1-800-897-LINK(5465), Division of Licensing and Background Checks, Abuse/Neglect of Seniors and Adults with Disabilities. Department of Human Services > For Providers > Clearances and Licensing > App for License. If you do not have or did not receive a current . COVID-19 Information and Resources. Mental Health Forms . Incident Report CCL-4605 - Word, Parent Notification of the Licensing Notebook CCL-5053 PDF, Parent Notification of the Licensing Notebook CCL-5053 - Word, Multiple Occupancy Documentation for Child Care Centers CCL- 2118 PDF, Multiple Occupancy Documentation for Child Care Centers CCL- 2118 Word, Ownership Interest Disclosure CCL-2119 PDF, Ownership Interest Disclosure CCL-2119 Word. The PDF versions are not fillable and are intended for printing.