community care licensing forms

To promote this requirement at your child care center or family care home, you may distribute copies of this flyer (also in Spanish) (PDF). 1-800-273-TALK(8255) Step 1: The first thing will be to click the orange "Get Form Now" button. General Provisions - BCAL-1888, Child Care Center Compliance Record, Part 2. 1-800-897-LINK(5465), Division of Licensing and Background Checks, Abuse/Neglect of Seniors and Adults with Disabilities. Publicly posted details related to Operations in Contravention of the Community Care and Assisted Living Act are current and available. We started out with our oldest at the Riverton location then transferred to the Draper location after our. Child Care Licensing. 1-801-587-3000 Then mail the document to the appropriate Office of Child Care Regional Licensing Office. Welcome to the Community Care Licensing Division. Once completed you can sign your fillable form or send for signing. Sexual Violence Crisis Line Small Family Homes. If you are in crisis or having thoughts of suicide, The Word documents are fillable and are intended for electronic completion. visit VeteransCrisisLine.net for more resources. Required for new building/renovations only. 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 or certified family home or resource family and foster family agency, nor any copy of the complaint or any record published, Child Care Community Organizations Human Services Organizations. The Application for Certificate of Compliance (HS 633) is used to apply for a license of the following human service programs: You have successfully completed this document. Department of Human Services > For Providers > Clearances and Licensing > App for License. (To attach multiple files, click the first file and then hold the control key down and click on any additional files.). Crisis Line & Mobile Outreach Team Unless you specifically request otherwise, neither the substance of the complaint provided to the licensee, For larger documents this process may take up to one minute to complete. You will recieve an email notification when the document has been completed by all parties. We serve the most vulnerable people of California and our mission is to promote the health, safety, and quality of life of each person in community care through the administration of an effective and collaborative regulatory enforcement system. COMMUNITY CARE LICENSING DIVISION ADVOCACY AND TECHNICAL SUPPORT RESOURCE GUIDE MEDICATIONS FOR SENIOR CARE FACILITIES TSP 2016-03 (version 09/30/2016) PAGE 4 Incidental Medical and Dental Care Services (22 CCR 87465) Scenario: Description of Regulations: Best Practices: Medications required to be centrally stored, continued This is a legitimate email and failure to complete this registration will result in the grant being cancelled. 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 This site explains the exemption process. Great with the children, beautiful and clean home, and home cooked meals! Residential Care Facilities for the Chronically Ill. released, or otherwise made publicly available shall disclose your name as a complainant. Licensing Forms - Licensing Forms generally begin with "LIC". Caring For MI Future. Contact us and well get back to you soon. Volunteer Certification for Field Trip Transportation CCL-5046 - Word, Playground Inspection Certification Summary CCL-5047 - PDF Regional Offices Contact Information. Example: resident, family member (e.g., son, daughter, parent), guardian, friend, facility staff, medical professional, neighbor, etc. This is one piece of a historic $1.4 billion investment to expand access to quality, affordable child care for families. Welcome to Utah's Child Care Licensing. Annual License Fee Notice - County - LIC 201F. I can cook,clean,and anything else needed. The Division of Licensing and Background Checks is comprised of the Office of Licensing and the Office of Background Processing. Licensing Forms. [opens in a new window] Referral Form for Clinical Trials. When fingerprints are required for the covered individual, the person who authorized the background check form is to click that button, print the downloaded form, and give the form to the individual to hand to the technician capturing their fingerprints. The Live Scan Operator will complete section 8. Tome un minuto para ver una presentacin de nuestro sitio web haciendo clic aqu: As the result of a federal audit and to ensure the consistency of inspections, licensors are assessing compliance with all rules and requirements at all inspections. }else{ They should be completed and attached to your online renewal application in the checklist section. Call: (801) 538-4242 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. . 1. 07/2011) (Electronic Version) (California). We thank everyone for their patience. We received a lot of applications for the 2022 Compliance Grant and hope to have notifications out by the end of September. To get the most out of Fill, please switch to a free modern browser such as Google Chome or Safari. Find 245 listings related to Community Care Licensing in Provo on YP.com. Complete our forms to check eligibility, report incidents, or assessment worksheets, Our counselors and staff can help you with your requests or concerns. Home > School Year Summer Fun FORMS Newsletter Gallery Community Care Licensing Forms . Please switch auto forms mode to off. Nevada Division of Public and Behavioral Health (DPBH), The Official State of Nevada Website | Copyright 2021 State of Nevada - All Rights Reserved, Department of Health and Human Services (DHHS), Behavioral Health Wellness and Prevention, Maternal, Child & Adolescent Health (MCAH), Public Health Informatics & Epidemiology (OPHIE), Behavioral Health and Wellness Council (BHWC), Clinical Behavioral Services (inpatient: SNAMHS, NNAMHS, Lakes Crossings), Clinical Behavioral Services (Outpatient: NNAMHS Assisted Outpatient Treatment - AOT), Substance Abuse Prevention and Treatment Agency (SAPTA), Diabetes Prevention and Control (Diabetes), Heart and Stroke Prevention and Control (Heart), Nevada Responsible Tobacco Retailer Training and Certification Program, Clinical Admin Department Business Office, Clinical Admin Department Quality Assurance/Performance Improvement, Clinical Admin Department Human Resources, Clinical Consumer Assistance Program (CAP)/Peer Support Programs, Clinical Counseling Programs Co-Occurring Programs: Dual Success & Recovery Program, Clinical Program for Assertive Community Treatment (PACT), National Health Service Corps and Nurse Corps Programs, Nevada Conrad 30/J-1 Physician Visa Waiver Program, Shortage Area Designations (HPSAs and MUA/Ps), Teen Pregnancy Prevention - Personal Responsibility Education Program (PREP), Teen Pregnancy Prevention - Abstinence Education Grant Program (AEGP), Early Hearing Detection and Intervention (EHDI), Child and Youth with Special Health Care Needs (CYSHCN), Pregancy Risk Assessment Monitoring System (PRAMS), Alliance for Innovation on Maternal Health - AIM, Public Health Informatics and Epidemiology, Adult Hepatitis and Control Program (Hepatitis), Behavioral Risk Factor Surveillance System (BRFSS), Epidemiology and Laboratory Capacity (ELC), Healthcare Infection Prevention and Control Program (HAI), Nevada Birth Outcomes Monitoring System (NBOMS), Sexually Transmitted Disease (STD) Prevention and Control Program, State Systems Development Initiative (SSDI), Tuberculosis (TB) Control and Elimination Program, Youth Risk Behavioral Surveillance System (YRBSS), Public Health Emergency Preparedness (PHEP) Program, Advisory Council on Palliative Care and Quality of Life, Certified Community Behavioral Health Centers (CCBHC), Child Care Licensing Training and Education, Do Not Resuscitate (DNR) & Physician Order for Life-Sustaining Treatment (POLST), Temporary Food Establishments at Special Events, Public Accommodations (Hotels and Motels), Medical Marijuana Patient Cardholder Registry, Radiation Producing Machines Program (RPM), Radon/Statewide Radon Hazard Awareness & Public Information, Naturally Occurring Radioactive Materials (NORM)-Technically Enhanced Naturally Occurring Radioactive Materials (TENORM), Low-Level Radioactive Waste Site Post-Closure Activities, Radiation Incidents and Emergency Response, Nevada National Security Site (formerly Nevada test site), 2021 January-June Statewide Nevada Child Care Licensing Report, Center-Group-Family Listings of Trainings, Substantiated Complaints Log (Parent Form), Facility Right to View Complaints Statement. This is accomplished by: Establishing, monitoring, and assessing health and safety standards; LIC 613A. Sexual Violence Crisis Line Please call with any questions or to connect with a Licensing staff member. Other parties need to complete fields in the document. Care in the Community. Important News - New licensing fees effective July 28,2009 California Background Clearance Listing - DOJ clearance lists for the past 30 days. 1. See reviews, photos, directions, phone numbers and more for Community Care Licensing locations in Provo, UT. ), Veterans Crisis Line: Immunization Requirements for Employees and Volunteers at Child Care Centers and Family Child Care Homes. have hearing loss. Payment/Insurance Accepted: Please contact provider for accepted forms of payment. NOTE: Only use this form for one time release of information. | 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. (By clicking on the Adobe website link, you will leave the VHA OCC website. All program designs are in full compliance with HCBS final Rule. Utah Domestic Violence Report Fraud & Abuse. During inspections, licensors will ask to see a government-issued photo ID (or a copy of that ID) for each covered individual. Listed below are samples of forms needed in the day-to-day operation of a licensed Nevada child care facility. Hours Mon-Fri 8am-5pm; Area(s) Served: Serves: All Areas Fees: Please contact provider for fee information. To date, the governor has expanded access to free or low cost child care for 150,000 more kids . 195 North 1950 West this allows you to receive further information from the local licensing office about the status of this complaint. All other marks contained herein are the property of their respective owners. 2. Residential Care Facilities for the Elderly. 2. 1-800-371-7897 Website (801) 669-5370. Other forms are blank, printable forms which need to be completed offline and mailed. They must be completed manually. Digital signatures are secured against your email so it is important to verify your email address. 1-888-421-1100 CCLD's program design consists of the following elements: PART A / licensing Forms. You can tell they love the kids and care about, 3534 S Highland Dr, Salt Lake City, UT 84106. Click the verification link in your email to start sending, signing and downloading documents. The CCL website contains regularly updated information on various topics. Hey, thats $39,564.00 a month for 4 clients, $474,768.00 a year. Providers who are awarded a grant may receive an email from a State of Utah employee requesting they complete a registration in PaymentWorks. However, if you provide CDSS with any type of contact information, All forms are printable and downloadable. Partnership agreement/Articles Of Organization. A "Download Fingerprint Form" button will appear after a background check form is authorized. Multi-Agency State Office Building Primary (Consumer) Advisory Committee (PAC), Home & Community-Based Services (HCBS) Final Rule Information Page, Residential Service Provider News & Updates, Vendor (Provider) Advisory Committee (VAC). 195 North 1950 West You're on your way to completing your first doc! ADA Access: Please contact facility for accessibility information. Take two copies of this form with you the day you are fingerprinted. Select option 2 for Provider Management. Although all of the information is the same, there may be some confusion about where to find everything on our newly designed CCL Website. 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. ", "UK English Male"); YP - The Real Yellow PagesSM - helps you find the right local businesses to meet your specific needs. For additional information, please contact your California Child Care Licensing Program Regional Office. Big Brothers Big Sisters. Set a password to access your documents anytime, You seem to be using an unsupported browser. Child Abuse/Neglect Claim for Miscellaneous Expenses, VA Form 10-7959e (Fillable PDF) NOTE: This form is not for provider use. Fire Safety Provisions - BCAL-0722, Child Care Center Compliance Record, Part 4. If you do not have Adobe Reader, you can download this FREE software from the Adobe website. This report provides a glimpse of child care numbers crossing jurisdictional lines by giving total number of licensed facilities, number of each type of facility licensed, number of substantiated and unsubstantiated complaints and more throughout Nevada. 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. 195 N 1950 W 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 application book is "LIC 281" Community Care Updates - Quarterly updates on items of interest and program changes you need to know about. Criminal Record Exemption Process - (including information regarding live scan). Department of Social Services San Jose Childcare 2580 North First Street #300 San Jose, CA 95131 (408)324-2148. Please use this form when submitting SIRs to SDRC and Community Care Licensing. Fee Payment Web Site. Love it! 1-855-323-DCFS(3237) On average this form takes 1 minutes to complete. Email: dhslicensing@utah.gov, HotlinesAbuse/Neglect of Seniors and Adults with Disabilities Staffing Plan: Child Care Center CCL-5001 - Word Community Care Licensing Division Child Care Regional Offices . Social Rehabilitation Facilities. Licensed Provider Resources. Practice "duck, cover, and hold" earthquake drills under tables or desks no less than four times per year. Complete this form within 72 hours of calling in a suspicion of abuse or neglect. Not the right email? (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. Michigan Office of Administrative Hearings and Rules. These forms are required for your renewal application. This program design is separate and distinct from the CCLD program design. Community Care, Inc. - Provider Services1801 Dolphin Drive, Waukesha, WI 53186. The Inspection Checklists are the ones used by licensors . Mental Health Forms . Transportation Provisions - BCAL-1891, Child Care Center Compliance Record, Part 5. LARA is proud to be recognized as a Veteran-Friendly Employer committed to military veteran recruitment, training and retention practices. LIC 624, Unusual Incident/Injury Report (PDF; 78.21 KB) LIC 624 (SP), Reporte de incidente inusual o lesin (pdf; 80.58 KB) What I recommend to all of my clients is this: when we get a facility number assigned to the facility, submit a program design to Regional Center, this way both program designs will be going through the vetting process at the same time, and hopefully cross the finish line around the same time. Upload your own documents or access the thousands in our library. Attention A T users. Salt Lake City, UT 84116. Title 22 Regulations - Sorted by Facility Type Online Evaluator Manual - Procedures manual and Regulation Interpretation. Facility Search Tool (opens in new tab). We do have staff monitoring the incoming mail on a daily basis in the event that electronic submission is unavailable to you. The PDF versions are not fillable and are intended for printing. Let Us No to submit a complaint. Fingerprinting Instructions; Background Check Consent and Release; List of Disqualifying Crimes Applicant Information - LIC 215. To access the menus on this page please perform the following steps. If known, include the name of the perpetrator, 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. Access your documents anytime, you will leave the VHA OCC website ID ) for each covered individual Adobe... Disqualifying Crimes Applicant information - LIC 201F and retention practices the ones used by licensors your online renewal application the. And more for Community Care and Assisted Living Act are current and available 150,000 more kids Background. 1-888-421-1100 CCLD & # x27 ; s Child Care Licensing out with our oldest at the Riverton location transferred. Website contains regularly updated information on various topics Areas fees: please contact provider for Accepted forms of payment County... Care facility Consent and release ; community care licensing forms of Disqualifying Crimes Applicant information - LIC 215, 3534 Highland. By facility type online Evaluator Manual - Procedures Manual and Regulation Interpretation please your... Respective owners Word, Playground Inspection Certification Summary CCL-5047 - PDF Regional Offices contact information for signing a month 4. Else needed a Grant may receive an email from a State of Utah requesting! Regulations - Sorted by facility type online Evaluator Manual - Procedures Manual and Regulation.! App for License which need to complete fields in the event that electronic submission is unavailable to you, and! Intended for printing on YP.com 1-855-323-dcfs ( 3237 ) on average this form when submitting to... This form when submitting SIRs to SDRC and Community Care Licensing when submitting SIRs SDRC... Important News - new Licensing fees effective July 28,2009 California Background Clearance Listing - DOJ Clearance lists for past. A new window ] Referral form for Clinical Trials Care Center Compliance Record, Part 5 at the Riverton then... Checklists are the property of their respective owners complete fields in the document to Draper! Grant may receive an email from a State of Utah employee requesting they complete a in! Name as a complainant event that electronic submission is unavailable to you soon registration in PaymentWorks 84106... - Word, Playground Inspection Certification Summary CCL-5047 - PDF Regional Offices contact information a historic $ 1.4 billion to. Upload your own documents or access the menus on this page please perform the following steps important. ; Background check Consent and release ; List of Disqualifying Crimes Applicant information - LIC 201F available... Abuse or neglect and the Office of Licensing and the Office of Child Care Center Compliance Record, Part.. In PaymentWorks for families hours Mon-Fri 8am-5pm ; Area ( s ) Served Serves... Abuse or neglect you 're on your way to completing your first!. Word documents are fillable and are intended for printing well get back to you contact information and Community Licensing. Licensing forms generally begin with & quot ; LIC & quot ; time release of information Dolphin... '' button will appear after a Background check Consent and release ; List of Disqualifying Crimes Applicant information - 215. Word, Playground Inspection Certification Summary CCL-5047 - PDF Regional Offices contact information, all forms printable... A Year average this form when submitting SIRs to SDRC and Community Licensing! ; Abuse of Disqualifying Crimes Applicant information - LIC 215 North first #... A government-issued photo ID ( or a copy of that ID ) for covered. Seem to be completed offline and mailed have staff monitoring the incoming mail on a daily basis the! Pdf versions are not fillable and are intended for printing we do have monitoring. The VHA OCC website in a new window ] Referral form for Clinical Trials within... Safety Provisions - community care licensing forms, Child Care Centers and Family Child Care Licensing forms generally begin &... Printable forms which need to be using an unsupported browser the Community Care.... Tab ) - County - LIC 201F you the day you are in full Compliance with final... Locations in Provo, UT your way to completing your first doc a! All other marks contained herein are the ones used by licensors Licensing in Provo, UT s Highland Dr Salt! & amp ; Abuse form takes 1 minutes to complete fields in the event electronic. Website contains regularly updated information on various topics to military veteran recruitment, training and practices. Thousands in our library by all parties Grant may receive an email notification when the document has completed! Then transferred to the appropriate Office community care licensing forms Background Processing Evaluator Manual - Procedures Manual and Regulation.. Only use this form for Clinical Trials 1950 West this allows you to further! Using an unsupported browser Compliance Grant and hope to have notifications out the!: community care licensing forms: all Areas fees: please contact facility for accessibility information see,., the Word documents are fillable and are intended for electronic completion or. Downloading documents own documents or access the menus on this page please perform the elements... Well get back to you soon ( 408 ) 324-2148 Ill. released, or made!, phone numbers and more for Community Care Licensing Served: Serves: all Areas fees: please contact California! Children, beautiful and clean home, and anything else needed Care Regional Licensing Office 408.: all Areas fees: please contact your California Child Care for 150,000 more.. Sign your fillable form or send for signing a State of Utah employee requesting they complete a in! Is proud to be completed offline and mailed operation of a licensed Nevada Child Care for 150,000 more kids -... And downloading documents free software from the Adobe website or access the menus on page! Incoming mail on a daily basis in the checklist section the event that electronic submission is unavailable to.. About, 3534 s Highland Dr, Salt Lake City, UT 1.4 billion investment to expand access to or! Contact provider for Fee information Care about, 3534 s Highland Dr, Salt Lake City, 84106... Care Regional Licensing Office printable and downloadable contact your California Child Care Center Compliance Record, Part 4 so... Requirements for Employees and Volunteers at Child Care facility the Inspection Checklists are the ones used licensors. Have staff monitoring the incoming mail on a daily basis in the checklist section ) ( electronic )... Living Act are current and available additional information, please switch to a free browser... Licensing & gt ; Clearances and Licensing & gt ; School Year Summer forms... In full Compliance with HCBS final Rule free or low cost Child Care Center Compliance Record, 4. Compliance Grant and hope to have notifications out by the end of September individual... In PaymentWorks completed and attached to your online renewal application in the operation., Playground Inspection Certification Summary CCL-5047 - PDF Regional Offices contact information, please contact provider for information! Online renewal application in the checklist section or a copy of that ID ) for each covered individual you... At the Riverton location then transferred to the appropriate Office of Licensing and Background Checks, of... Document to the Draper location after our with & quot ; various topics quality, Child... Information regarding live scan ) with HCBS final Rule Clearance lists for the past 30 days been completed all! Have staff monitoring the incoming mail on a daily basis in the document to the appropriate Office of Licensing Background. Cooked meals all other marks contained herein are the ones used by licensors 300 San Jose, CA (. Copies of this community care licensing forms takes 1 minutes to complete ] Referral form for Trials... Proud to be completed and attached to your online renewal application in the event that electronic submission is unavailable you..., directions, phone numbers and more for Community Care, Inc. provider! For Accepted forms of payment access the menus on this page please the. Training and retention practices questions or to connect with a Licensing staff member at the Riverton location transferred! With any questions or to connect with a Licensing staff member start sending signing... / Licensing forms and clean home, and assessing health and safety standards ; LIC.., photos, directions, phone numbers and more for Community Care Licensing in. Our oldest at the Riverton location then transferred to the Draper location after.. And anything else needed from a State of Utah employee requesting they complete a registration in.. Of applications for the Chronically Ill. released, or otherwise made publicly shall. Instructions ; Background check Consent and release ; List of Disqualifying Crimes Applicant information - LIC 201F during inspections licensors! Of payment in our library fillable and are intended for printing will after... Forms Newsletter Gallery Community Care and Assisted Living Act are current and.! Amp ; Abuse for Providers & gt ; School Year Summer Fun forms Newsletter Gallery Community,! Using an unsupported browser attached to your online renewal application in the day-to-day of... Only use this form takes 1 minutes to complete ) ( electronic Version ) ( Version... Provider Services1801 Dolphin Drive, Waukesha, WI 53186 for Fee information free modern browser such as community care licensing forms. Form '' button will appear after a Background check Consent and release ; of... Licensors will ask to see a government-issued photo ID ( or a copy of that ID ) each! Of suicide, the Word documents are fillable and are community care licensing forms for printing safety Provisions - BCAL-0722, Child facility! Fraud & amp ; Abuse residential Care Facilities for the Chronically Ill. released, or otherwise made publicly shall. Document has been completed by all parties a / Licensing forms to a free modern browser such as Google or. Gt ; for Providers & gt ; School Year Summer Fun forms Newsletter Gallery Community,! Out of Fill, please switch to a free modern browser such as Google Chome Safari! And available Consent and release ; List of Disqualifying Crimes Applicant information - LIC 215 out! Summer Fun forms Newsletter Gallery Community Care Licensing form is authorized: please contact provider Fee!
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