California Code of Regulations
Title 22 - Social Security
Division 6 - Licensing of Community Care Facilities
Chapter 3 - Adult Day Programs
Article 1 - General Requirements
Section 82003 - Definitions - Forms

Universal Citation: 22 CA Code of Regs 82003

Current through Register 2024 Notice Reg. No. 38, September 20, 2024

(a) The following forms, which are incorporated by reference, apply to the regulations in Title 22, Division 6, Chapter 3 (Adult Day Programs):

(1) LIC 195 (10/05) -- Notice of Operation in Violation of Law.

(2) LIC 200 (8/04) -- Application for a Community Care Facility or Residential Care Facility for the Elderly License.

(3) LIC 300A (9/03) -- Removal Confirmation -- Exemption Needed.

(4) LIC 300B (9/03) -- Removal Confirmation -- Denial.

(5) LIC 300C (9/03) -- Removal Confirmation -- Rescinded.

(6) LIC 300D (9/03) -- Removal Confirmation -- Non-Exemptible.

(7) LIC 301E (7/03) -- Reference Request Form.

(8) LIC 309 (6/01) -- Administrative Organization

(9) LIC 400 (1/99) -- Affidavit Regarding Client/Resident Cash Resources.

(10) LIC 508 (1/03) -- Criminal Record Statement.

(11) LIC 602 (10/99) -- Physician's Report for Community Care Facilities.

(12) LIC 9054 (3/99) -- Local Fire Inspection Authority Information

(13) LIC 9117 (2/00) -- Emergency Approval to Operate.

(14) LIC 9158 (11/04) -- Telecommunications Device Notification.

(15) LIC 9182 (4/02) -- Criminal Background Clearance Transfer Request.

(16) LIC 9188 (9/03) -- Criminal Record Exemption Transfer Request.

1. New section filed 12-13-2006; operative 1-12-2007 (Register 2006, No. 50).

Note: Authority cited: Sections 1530 and 1530.1, Health and Safety Code. Reference: Sections 1508, 1520, 1522, 1540 and 1541, Health and Safety Code; and Section 2881, Public Utilities Code.

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