Form Lic 281 - Application Instructions For A Facility License (Page 2 of 22) in pdf

Community Care Licensing Division (CCLD)

Application Booklet for Facility License

INTRODUCTION — These instructions are intended to help you file an application for a facility

license for the facility types listed on the cover. Attached are the instructions for filing the

application. Before a license can be issued, the licensing agency must review information that

you meet the minimum requirements for the license.

The application fee plus section A and B documents must be completed and sent to the licensing

agency as a packet. The application fee is non-refundable. Your application cannot be started

until all the forms are filed with the licensing agency. The page entitled, “Section A, Forms by

Type of Facility has links that will take you directly to each licensing form. If you need additional

forms, our website is or contact our licensing agency. By printing out forms

online, you are assured of using the most current licensing form.

Submit the Section A and B documents in the same sequence as they are in the application

booklet. If the forms are incomplete, the licensing agency will return the entire packet to you. To

prevent delays, be sure that you have all the necessary information completed, properly signed,

with original signatures, and dated. Make a photocopy of your application before you give it to

the licensing agency.

REGULATIONS — The regulations that govern the licensing of all facility categories covered by

these application instructions are under the California Code of Regulations, Title 22, Division 6.

Copies

the

regulations

and

amendments

can

downloaded

from

For information on purchasing regulations with an update service, contact:

Barclays West Group

1-800-888-3600

RESIDENTIAL CARE FACILITY FOR THE CHRONICALLY ILL — If you are applying for an RCF-CI

license, your application must contain all of the items in Sections A and B plus some additional

items. Refer to California Code of Regulations, Title 22, Division 6, Chapter 8.5, Section 87818

(the RCF-CI Regulations) for detailed information on the additional required items.

INFORMATION PRACTICE ACT: — This information is requested by the Department of Social Services in compliance with Title 22,

Division 6 of the California Code of regulations and Section 1500 and 1569 et. Seq. of Health and Safety Code. Submission of the

information is mandatory. The local licensing office is responsible for maintaining the information. Access to this information will be

provided unless prohibited by the Information Practice Act of 1977. Certain authorized public and private agencies may have access to

this information including county Welfare Departments, Department of Justice, Regional Centers, the Department of Developmental

Services and the Department of Mental Health.

Form Lic 281 - Application Instructions For A Facility License Page 2