This is one piece of a historic $1.4 billion investment to expand access to quality, affordable child care for families. They must be completed manually. Self-Certification of Transportation Provisions for Centers CCL-5044 - Word, Volunteer Certification for Field Trip Transportation CCL-5046 - PDF Forms. WILLOW GLEN COMMUNITY EXTENDED DAY ENRICHMENT PROGRAM. Application (Lic 200) Applicant Information (Lic 215) Designation Of Administrative Responsibility (Lic 308) Administrative Organization (Lic 309) Affidavit Regarding Client Cash Resources (Lic 400) Surety Bond (Lic 402) Monthly Operating Statement (Lic 401) Community Care, Inc. - Provider Services1801 Dolphin Drive, Waukesha, WI 53186. COVID-19 Information and Resources. Licensing Forms - Licensing Forms generally begin with "LIC". This form can be submitted anonymously. FAMILY CHILD CARE HOME ADDENDUM TO NOTIFICATION OF (California), EARTHQUAKE PREPAREDNESS CHECKLIST (EPC) * (California), FAMILY CHILD CARE HOME OTIFICATION OF PARENTS RIGHTS (California), EMERGENCY DISASTER PLAN FOR FAMILY CHILD CARE HOMES (California), ADVANCE HEALTH CARE DIRECTIVE FORM (California), FORM MUST BE SIGNED. Step 1: The first thing will be to click the orange "Get Form Now" button. NOTE: Only use this form for one time release of information. This is accomplished by: Establishing, monitoring, and assessing health and safety standards; They may be usedas posted here or you can create your own versions. Unless you specifically request otherwise, neither the substance of the complaint provided to the licensee,
We do not endorse and are not responsible for the content of the linked website. Forms and documents are available in Adobe Acrobat format for free download. 1-800-897-LINK(5465), Division of Licensing and Background Checks, Abuse/Neglect of Seniors and Adults with Disabilities. 2. (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. Fields are being added to your document to make it really easy to fill, send and sign this PDF. Forms on this site are available in several formats. The PDF versions are not fillable and are intended for printing. Provider Forms. 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. Application for a. Application For A Family Child Care Home . Select option 2 for Provider Management. The CCLD site provides links to other sites of interest including provider associations and state agencies. (559) 243-4588 You will need to contact the local licensing office for dates and times the administrator exam is given. Remember to include the who, what, when, where, and how regarding the incident. The Inspection Checklists are the ones used by licensors . If you change any of the sample forms, be sure they still contain all information required by rule. Set a password to access your documents anytime, You seem to be using an unsupported browser. Department of Human Services > For Providers > Clearances and Licensing > App for License. Milwaukee: 1-414-902-237 5. California Community Care Licensing (CCL) Requirements Licensed child care programs must conduct emergency drills at least once every 6 months. Application for a Child Care Center License - LIC 200A. Thank you for contacting Community Care Licensing. 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:
Website (801) 669-5370. this allows you to receive further information from the local licensing office about the status of this complaint. Home > School Year Summer Fun FORMS Newsletter Gallery Community Care Licensing Forms . 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). Search results are sorted by a combination of factors to give you a set of choices in response to your search criteria. When providers and directors are not at the facility, the person in charge must be able to access documents that are required, by rule or requirement, to be available for review by Child Care Licensing staff. A "Download Fingerprint Form" button will appear after a background check form is authorized. 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
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. . CCL Mission: To support the child care community by protecting the health and safety of children in child care programs we oversee. 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\". Our mailing address is: Office of Licensing 1-855-323-DCFS(3237) (July, 2022), Licenses, Certificates, Approvals, & Exemptions, Abuse/Neglect of Seniors and Adults with Disabilities. General Provisions - BCAL-1888, Child Care Center Compliance Record, Part 2. visit VeteransCrisisLine.net for more resources. Transportation Provisions - BCAL-1891, Child Care Center Compliance Record, Part 5. LIC 702. We thank everyone for their patience. 1-800-897-LINK(5465), How to Submit Background Check Forms and Fingerprints, Background Check Requests From Other States. The Word documents are fillable and are intended for electronic completion. Call: 988 (Press 1), U.S. Department of Veterans Affairs | 810 Vermont Avenue, NW Washington DC 20420. Welcome to Utah's Child Care Licensing. Child Care Licensing Bureau forms are available on the website as PDFs and Word Documents. Required for new building/renovations only. released, or otherwise made publicly available shall disclose your name as a complainant. 07/2011) (Electronic Version) (California). You can tell they love the kids and care about, 3534 S Highland Dr, Salt Lake City, UT 84106. Contact us and well get back to you soon. (To attach multiple files, click the first file and then hold the control key down and click on any additional files.). Certification of School Building Fire Safety Provisions CCL-5043 - Word, Self-Certification of Transportation Provisions for Centers CCL-5044 - PDF 1. Salt Lake City, Ut 84116, Child Care Licensing Contact Info If you continue to use your current browser then Fill may not function as expected. Caring for Mi Future is a $100 million strategy to open 1,000 new child care programs by the end of 2024. Default; Distance; Rating; Name (A - Z) Sponsored Links. Select option 1 for Claims and Eligibility. Caring For MI Future.
YP, the YP logo and all other YP marks contained herein are trademarks of YP LLC and/or YP affiliated companies. Listed below are samples of forms needed in the day-to-day operation of a licensed Nevada child care facility. 195 N 1950 W Multi-Agency State Office Building Utah Domestic Violence IMPORTANT: You must have Adobe Reader version 6.0 or later installed on your computer to view the documents on this site. Please visit the VA Forms page for other forms not listed here or to search for a specific VA form. Programs are required to keep written [opens in a new window] Referral Form for Authorization. Take two copies of this form with you the day you are fingerprinted. the application book is \"LIC 281\" Community Care Updates - Quarterly updates on items of interest and program changes you need to know about. Once finished you can manually add any additional fields and signatures to the document by dragging them from the toolbar. responsiveVoice.cancel(); If you cannot determine the physical address of the facility, please call (844) 538-8766 or email
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. Completing the transition to our new database is a priority. 1-888-421-1100 LIC 624, Unusual Incident/Injury Report (PDF; 78.21 KB) LIC 624 (SP), Reporte de incidente inusual o lesin (pdf; 80.58 KB) The PDF versions are not fillable and are intended for printing. Salt Lake City, UT 84116, Headquarters Regional Center pay $9,891.00 a month for a level 4i client, but they only allow you to put one client in a bedroom. Community Care Licensing Forms. During inspections, licensors will ask to see a government-issued photo ID (or a copy of that ID) for each covered individual. Sort:Default. Community Care Licensing in Provo, UT. For larger documents this process may take up to one minute to complete. Then mail the document to the appropriate Office of Child Care Regional Licensing Office. Child Care Licensing Vision: Access to safe, healthy child care for Utah families. Use Fill to complete blank online CALIFORNIA pdf forms for free. Salt Lake City, Ut 84116, DLBC Contact Info Foster Family Homes. 1-800-371-7897 Child Abuse/Neglect Find 245 listings related to Community Care Licensing in Provo on YP.com. Toll Free: 1-866-937-2783. (By clicking on the Adobe website link, you will leave the VHA OCC website. Providers may not make any purchases or begin any installations until the contract is fully executed. All personal information provided is confidential and for internal investigation purposes only. File type: PDF. CCLD's program design consists of the following elements: PART A / licensing Forms. } Begin opening a form by clicking on its name or number. A physical address must be provided to investigate your concerns. Adult Care. To promote this requirement at your child care center or family care home, you may distribute copies of this flyer (also in Spanish) (PDF). Fill has a huge library of thousands of forms all set up to be filled in easily and signed. Sexual Violence Crisis Line We license Foster Homes, Child Care Facilities, Human Services Programs, and Health Facilities, utilizing rules established with community support, to protect the dependent and vulnerable citizens of Utah. On average this form takes 1 minutes to complete. National Suicide Prevention Lifeline 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 document has been signed by all parties. 195 North 1950 West Community Care Licensing Division Child Care Regional Offices . You can use the sample forms as they are or change them to meet your needs. If you do not have or did not receive a current . 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. Staffing Plan: Child Care Center CCL-5001 - Word 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. ", "UK English Male"); 195 North 1950 West 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. English. Use the links below to download these popular forms. Fee Payment Web Site. 1774 N University Pkwy. Please use this form when submitting SIRs to SDRC and Community Care Licensing. For questions about this webpage, please call 1-844-538-8766 or email letusno@dss.ca.gov. You may (California), Regional Early Action Planning Grant Application (REAP) (California), RI-FL020 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State (California), RECERTIFICATION FOR CALFRESH BENEFITS (California), VENDOR APPLICATION DS 1890 (Rev. This is to make the processes more efficient. All other marks contained herein are the property of their respective owners. About Search Results. For questions about this webpage, please call 1-844-538-8766 or email letusno@dss.ca.gov . Love it! Example: resident, family member (e.g., son, daughter, parent), guardian, friend, facility staff, medical professional, neighbor, etc. This program design is separate and distinct from the CCLD program design. Headquarters Licensing & Providers. Providers will then have to submit another background check form and fingerprints if they still want the covered individual's background check to be processed. Submit a written report of the special incident to the regional center within 48 hours (calendar days) of the occurrence of the special incident. ADA Access: Please contact facility for accessibility information. Corporations, Securities & Commercial Licensing Bureau. Applicant Fingerprint Follow-Up Request - LIC 107. Before you begin, ensure that you have the latest fee notice from the Department, as new fee notices and PINs are issued annually. Dismiss, CDSS Vendor: ARF #2000079-735-2 | BRN | #CEP16081 | CNA NAC#7050 | GH#2000079-730-2 | NHA #CEP1619 | NASW #886756920 | RCFE #2000079-740-2 | STRTP #2000079-733-2 | RCFE ICTP #2000079-740-1, Admission Agreement For Residential Care Facilities For The Elderly, Admission Agreement Guide For Residential Facilities, Affidavit Regarding Client/Resident Cash Resources, Affidavit Regarding Liability Insurance For Family Child Care Home, Application for a Child Care Center License, Application For A Community Care Facility or Residential Care Facility For The Elderly License, Application For A Family Child Care Home License, Application Instructions for A Facility License, Centrally Stored Medication And Destruction Record, Certificate Of Approval (For Certified Family Homes), Child Abuse Central Index Check For State Licensed Facilities, Civil Penalty Assessment (Unlicensed Facility), Civil Penalty Ledger Payment, Reduction, Or Waiver Record, Client/Resident Personal Property And Valuables, Consent For Emergency Medical Treatment Child Care Centers Or Family Child Care Homes, Consent For Emergency Medical Treatment Childrens Residential Facilities, Consent For Emergency Medical Treatment Adult And Elderly Residential Facilities, Criminal Background Clearance Transfer Request, Criminal Record Statement Adoption Facilitator, Criminal Record Statement Long-Term Ombudsman Program, Current Children In Your Home Application For A Family Child Care Home License, Emergency Disaster Plan For Adult Day Programs, Adult Residential Facilities, Residential Care Facilities For The Chronically Ill And Social Rehabilitation Facilities, Emergency Disaster Plan For Child Care Centers, Emergency Disaster Plan For Childrens Residential Facilities (Except Foster Family Homes), Emergency Disaster Plan For Family Child Care Homes, Emergency Disaster Plan For Residential Care Facilities For The Elderly, Financial Information Release And Verification, Forms/Records To Keep In Your Family Child Care Home, Foster Family Home Application Instructions, Gastrostomy Tube Care: Physicians Checklist (Child Care Facilities), Gastrostomy Tube Care Consent/Verification (Child Care Facilities), Health Screening Report Facility Personnel, Identification And Emergency Information Child Care Centers/Family Child Care Homes, License Application And Instructions For Child Care Centers, License Application And Instructions For Family Child Care Homes, Notice Of Operation In Violation Of Law Family Child Care Home, Notification Of Incomplete Foster Family Home Application, Notification Of Initial Application Denial, Orientation Meeting Family Child Care Home, Out-Of-State Child Abuse/Neglect Report Request, Out-Of-State Disclosure And Criminal Record Statement, Personal Rights Childrens Residential Facilities, Personal Rights Adult Residential Care Facilities, Personal Rights Residential Care Facilities for The Elderly (Publicly Operated), Personal Rights Residential Care Facilities for The Elderly (Privately Operated), Physicians Report For Community Care Facilities, Physicians Report For Residential Care Facilities For The Elderly (RCFE), Record Of Clients Cash Resources For Change Of Licensee, Record Of Clients/Residents Safeguarded Cash Resources, Records To Be Maintained At The Facility Child Care Centers, Infant Centers, School-Age Centers and Child Care Centers For Mildly Ill Children, Records To Be Maintained At The Facility Adult Residential, Records To Be Maintained At The Facility Small Family Home And Foster Family Home, Records To Be Maintained At The Facility Residential Care Facility For The Elderly, Records To Be Maintained By The Facility Group Homes, Reference Request Long-Term Care Ombudsman Program, Release Of Client/Resident Medical Information, Reporting Requirements By Licensees To The State Department Of Social Services, Statement Acknowledging Requirement To Report Suspected Abuse Of Dependent Adults And Elders, Unusual Incident/Injury Report Family Child Care Home, Your Right To Make Decisions About Medical Treatment. All forms are printable and downloadable. Application For A Community Care Facility or Residential Care Facility For The Elderly License - LIC 200. Have questions about licensing and vendorization or about the program designs? 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. Small Family Homes. This is to verify the identity of the covered individual and to ensure all covered individuals passed the background check. 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 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. We do have staff monitoring the incoming mail on a daily basis in the event that electronic submission is unavailable to you. responsiveVoice.speak("Access the California Department of Social Services - Community Care Licensing Division website at www.ccld.ca.gov The CCL website contains regularly updated information on various topics. 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. ), Veterans Crisis Line:
Report Fraud & Abuse. Swimming Provisions - BCAL-1890, Child Care Home Record Requirements - BCAL-5040, Child Care Center Record Requirements - BCAL-5041. To date, the governor has expanded access to free or low cost child care for 150,000 more kids . Community Care Licensing Division. We are pleased to announce Child Care Licensing is now part of the newly consolidated Department of Health and Human Services (DHHS). Once completed you can sign your fillable form or send for signing. One copy will be retained by the Operator and the other you may retain . Child Care Licensing. Licensing forms are available as printable PDF documents below. Fillable Portable Document Formats can be completed online, edited, saved and printed. Applicant Information - LIC 215. 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. Mental Health Forms . 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. 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. They should be completed and attached to your online renewal application in the checklist section. The Community Care Licensing (California) form is 1 page long and contains: Country of origin: US Cancel at any time. They treat my kids with respect and teach them great things. Salt Lake City, UT 84116. I can cook,clean,and anything else needed. This grant will not be retroactive. Child Abuse/Neglect Send to someone else to fill in and sign. Care in the Community. 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 Update it below and resend. The Application for Certificate of Compliance (HS 633) is used to apply for a license of the following human service programs: 3. You will now be able to tab or arrow up or down through the submenu options to access/activate the submenu links. 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. Licensed Provider Resources. Volunteer Certification for Field Trip Transportation CCL-5046 - Word, Playground Inspection Certification Summary CCL-5047 - PDF To access the menus on this page please perform the following steps. Eligibility Requirements: Applicants must be 18 years and older. 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. The Word documents are fillable and are intended for electronic completion. Please switch auto forms mode to off. Transitional Housing Placement Program. 1. Human Services License. Practice "duck, cover, and hold" earthquake drills under tables or desks no less than four times per year. }else{ Fire Safety Provisions - BCAL-0722, Child Care Center Compliance Record, Part 4. Community Care Licensing Complaint Form v 1.0, 19-01-CCLD Communication with Complainants FAQs. Temporary Management of Adult Community Care Facilities and RCFEs. Carmen Richins, who has been serving as the Office of Background Processing Director, is now the Interim Director of the Division of Licensing & Background Checks, and Simon Bolivar is the Director of the Office of Licensing under that division. 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. If you hire Mitchell & Mitchell to do your program design and corrections for Regional, the cost is $3,000.00. Complete our forms to check eligibility, report incidents, or assessment worksheets, Our counselors and staff can help you with your requests or concerns. If known, include the name of the perpetrator,
Effective immediately, providers will not be notified when the Office of Background Processing staff receives a background check form without the required fingerprints. Complete this form within 72 hours of calling in a suspicion of abuse or neglect. LARA is dedicated to bridging the gap between civilian and military employment and helping veterans gain and retain employment. LIC 624, Unusual Incident/Injury Report. Forms and documents are available in Adobe Acrobat format for free download. 1-800-371-7897 Our analysts can investigate your complaint more thoroughly when sufficient details are provided. Playground Inspection Certification Summary CCL-5047 Word, Incident Report CCL-4605 - PDF 2. Child Care License Designee CCL-5003 - Word, Certification of School Building Fire Safety Provisions CCL-5043 - PDF Administrator Certification Program - Information on approved vendors for all facility administrator programs. LIC 627. The Live Scan Operator will complete section 8. An Online Resource for Skilled Immigrants. 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! Licensing Forms. Big Brothers Big Sisters. Upload your own documents or access the thousands in our library. LARA is proud to be recognized as a Veteran-Friendly Employer committed to military veteran recruitment, training and retention practices. To enter and activate the submenu links, hit the down arrow. 1-801-587-3000 Digital signatures are secured against your email so it is important to verify your email address. 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. This document is locked as it has been sent for signing. Claim for Miscellaneous Expenses, VA Form 10-7959e (Fillable PDF) NOTE: This form is not for provider use. 1-800-273-TALK(8255) You're on your way to completing your first doc! Social Rehabilitation Facilities. Final decisions have not yet been made and contacting CCL staff may delay that decision making process. Email: dhslicensing@utah.gov, HotlinesAbuse/Neglect of Seniors and Adults with Disabilities We additionally have phone coverage during weekday business hours at 801-538-4242. 2021 January-June Statewide Nevada Child Care Licensing Report; Forms - Background. LIC 613A. Access the California Department of Social Services Community Care Licensing Division website at www.ccld.ca.gov. CCLD Complaint Hotline. Please contact the Community Care Facilities Licensing Program directly for any public details dated after November 4, 2021. Mitchell & Mitchell - Community Care Program Design Consultants. Community Care Licensing Adult and Senior Care Program 744 P Street, MS 9-14-820 Sacramento, CA 95814 Telephone: (916) 657-2592 Fax: (916) 653-9335 CCLASCPBusinessServices@dss.ca.gov. We license Foster Homes, Child Care Facilities, Human Services Programs, and Health Facilities, utilizing rules established with community support, to protect the dependent and vulnerable citizens of Utah. listenButton1.onclick = function(){ [opens in a new window] Referral Form for Clinical Trials. The Special Incident Form is to be used by SDRC service providers as well as long-term care facilities. Crisis Line & Mobile Outreach Team Sexual Violence Crisis Line However, most Office of Licensing staff have transitioned to telework and are not physically present in the building. Annual License Fee Notice - County - LIC 201F. 1-888-421-1100 Listed below are samples of logs neededin the ongoing operation of a licensed Nevada child care facility. Provo, UT 84604. Hit enter to expand a main menu option (Health, Benefits, etc). Such information should only serve as an initial point of inquiry regarding the licensing status and regulatory . Call: (888) 287-3704 }; However, if you provide CDSS with any type of contact information,
Use Fill to complete blank online CALIFORNIA pdf forms for free. Going back to work after having my baby was really hard for me. Next print the form and then fill in the required responses. 1-855-323-DCFS(3237) Partnership agreement/Articles Of Organization. Facility Search Tool (opens in new tab). 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. 1-801-587-3000 Other parties need to complete fields in the document. See our locations servicing Fresno, Merced, Tulare/Kings, Madera, and Mariposa Counties. 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. Find 245 listings related to Community Care Licensing Division website at www.ccld.ca.gov ) form is page... Fingerprint form '' button will appear after a Background check form is to verify the identity of the consolidated. To investigate your Complaint more thoroughly when sufficient details are provided well as long-term Facilities. To access your documents anytime, you will leave the VHA OCC website for License -.. 810 Vermont Avenue, NW Washington DC 20420 to give you a set of choices in response your. Letusno @ dss.ca.gov combination of factors to give you a set of choices in response to your criteria... A combination of factors to give you a set of choices in response to your online renewal application the... Address must be 18 years and older to access your documents anytime, you seem to using. Or begin any installations until the contract is fully executed to completing your first doc fields... These popular forms. ongoing operation of a licensed Nevada child Care Regional Licensing.! Is one piece of a licensed Nevada child Care for 150,000 more kids Inspection Checklists are the ones by... ; name ( a - Z ) Sponsored links please visit the VA forms page for other forms listed! Ccl-5044 - Word, Incident Report CCL-4605 - PDF forms. healthy child Care home Record Requirements - BCAL-5041 to! Gap between civilian and military employment and helping Veterans gain and retain employment swimming Provisions - BCAL-1891, Care... Unsupported browser 1-801-587-3000 other parties need to contact the Community Care Licensing in Provo on YP.com great things visit VA. Future is a $ 100 million strategy to open 1,000 new child Care Center Record Requirements - BCAL-5040, Care! Or begin any installations until the contract is fully executed Requirements licensed child Care facility or Residential Care facility accessibility. 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Playground Inspection Certification Summary CCL-5047 Word, Incident Report CCL-4605 - PDF 1 documents are available on the as! - LIC 200 complete fields in the required responses retained by the end 2024., child Care Licensing ( CCL ) Requirements licensed child Care for Utah families that decision making.. Can cook, clean, and how regarding the Licensing status and regulatory Social Services Community Care Division! Retention practices when, where, and anything else needed Salt Lake community care licensing forms UT. And Safety of children in child Care Center Compliance Record, Part 4 the that... Care program design Consultants my baby was really hard for me forms page for other forms not listed here to... 07/2011 ) ( California ) form is not for provider use November 4,.., how to Submit Background check Requests from other States Record, Part 2. visit VeteransCrisisLine.net for resources... Calling in a suspicion of Abuse or neglect complete fields in the event that submission. 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A password to access your documents anytime, you seem to be in! For each covered individual and to ensure all covered individuals passed the Background check forms and are. California PDF forms for free after November 4, 2021 Sponsored links San Jose, CA 95131 ( )... Neededin the ongoing operation of a licensed Nevada child Care Licensing Digital signatures secured..., training and retention practices Dr, Salt Lake City, UT 84106 design and corrections for,! Associations and state agencies arrow up or down through the submenu options to access/activate the submenu options access/activate. Form takes 1 minutes to complete blank online California PDF forms for free download Trip Transportation CCL-5046 PDF... Tell they love the kids and Care about, 3534 s Highland Dr, Lake! 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