CA HHSA DSS LIC 9142A 2016-2025 free printable template
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STATE OF CALIFORNIA HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION ROSTER OF PARTICIPANTS FOR VENDOR USE ONLY-I CTP OR CEU COURSES ADMINISTRATOR
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How to fill out CA HHSA DSS LIC 9142A
01
Obtain the CA HHSA DSS LIC 9142A form from the California Department of Social Services website or your local licensing office.
02
Fill in your personal information at the top of the form, including your name, address, and phone number.
03
Provide details about the type of care you are providing, including the number of children and their ages.
04
Include information about your employment history and any relevant training or certifications.
05
Respond to questions regarding background checks and provide any required documentation.
06
Review your completed form for accuracy and completeness.
07
Sign and date the form before submission.
08
Submit the form to the appropriate licensing authority along with any required fees.
Who needs CA HHSA DSS LIC 9142A?
01
Individuals or organizations applying for a license to provide foster care, childcare, or other community care services in California.
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What is CA HHSA DSS LIC 9142A?
CA HHSA DSS LIC 9142A is a form required by the California Department of Social Services for reporting specific information related to the licensing of community care facilities.
Who is required to file CA HHSA DSS LIC 9142A?
Individuals or organizations operating community care facilities in California are required to file CA HHSA DSS LIC 9142A.
How to fill out CA HHSA DSS LIC 9142A?
To fill out CA HHSA DSS LIC 9142A, gather the necessary details about your facility, including the facility license number and relevant operational information, then complete the form as per the instructions provided by the California Department of Social Services.
What is the purpose of CA HHSA DSS LIC 9142A?
The purpose of CA HHSA DSS LIC 9142A is to ensure compliance with state regulations for community care facilities and to facilitate the gathering of essential operational data.
What information must be reported on CA HHSA DSS LIC 9142A?
The information that must be reported on CA HHSA DSS LIC 9142A includes facility identification details, operational capacity, services provided, and any changes in ownership or administration.
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