(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(5) LIC 300C (9/03) -- Removal Confirmation -- Rescinded.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.
Credits
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.
1. New section filed 12-13-2006; operative 1-12-2007 (Register 2006, No. 50).
This database is current through 6/14/24 Register 2024, No. 24.
Cal. Admin. Code tit. 22, § 82003, 22 CA ADC § 82003
