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CALIFORNIA DEPARTMENT OF SOCIAL SERVICESSTATE OF CALIFORNIA HEALTH AND HUMAN SERVICES AGENCYINSTRUCTIONS: Post a copy in a prominent location in facility, near telephone. Licensee is responsible for

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How to fill out lic 610 - california

01

Start by obtaining the LIC 610 form from the California Department of Social Services (CDSS) website or visiting a local CDSS office.

02

Read the instructions on the form carefully before you begin filling it out.

03

Provide your personal information such as name, address, phone number, and Social Security Number.

04

Specify the type of facility you are operating or planning to operate.

05

Provide details about the facility, including its physical address, contact information, and capacity.

06

Indicate the type of care or services provided by the facility.

07

Fill out the sections regarding the personnel working at the facility, including their names, positions, and required qualifications.

08

Provide information on any previous licenses or certifications held by the facility and the status of those licenses.

09

Read and provide the disclosure and certification statements at the end of the form, ensuring you understand the legal obligations and responsibilities.

10

Sign and date the form.

11

Make a copy of the completed LIC 610 form for your records.

12

Submit the original form to the appropriate CDSS office either in person or by mail.

13

Keep a record of the date and method of submission for future reference.

Who needs lic 610 - california?

01

Anyone operating or planning to operate a facility in California that provides care or services to individuals, including but not limited to foster family homes, residential care facilities, community care facilities, child care centers, and adult day care centers, may need to fill out LIC 610 form.

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What is lic 610 - california?

LIC 610 is a form used in California for reporting certain financial information related to specific licensing requirements.

Who is required to file lic 610 - california?

Individuals or entities that hold specific licenses in California which require compliance with financial reporting must file LIC 610.

How to fill out lic 610 - california?

To fill out LIC 610, you need to provide accurate and complete financial information as required by the form's instructions, ensuring all sections are properly completed.

What is the purpose of lic 610 - california?

The purpose of LIC 610 is to ensure that licensed entities report their financial status for regulatory oversight and compliance.

What information must be reported on lic 610 - california?

LIC 610 requires the reporting of financial statements, details of income and expenses, and other relevant financial data as specified in the form.

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