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  • Forms Brochures - California Dept. of Social Services
    CDSS collects personal information directly from individuals who volunteer to obtain some of our services Collection of this information is required to deliver the specific services, but use of these services is voluntary
  • Forms and Publications (I-L) - California Dept. of Social Services
    L Forms LIC 01A (6 23) - Resource Family Application LIC 01C (7 16) - Resource Family Application-Confidential LIC 03 (7 23) - Resource Family Home Health And Safety Assessment Checklist Document For Agency Use Only LIC 05A (8 21) - Resource Family Approval Certificate LIC 08 (2 24) - Intensive Services Foster Care Unit (ISFC) Written Assessment of Risk and Compatibility LIC 12 (8 21
  • Forms - by Program
    To find a form, click on the link after the program name to find forms whose form number begins with those letters
  • Alphabetic List - Forms
    Don't know the number of the form you need? See Forms - Listed by Program
  • Forms and Publications (Q-T) - California Dept. of Social Services
    SOC 2313 (3 20) - In-Home Supportive Services (IHSS) Program Exemption From Workweek Limits For Extraordinary Circumstances (Exemption 2) State Administrative Review Request Form SOC 2320 (10 17) - In-Home Supportive Services (IHSS) And Waiver Personal Care Services (WPCS) CDSS Violation Removal Request
  • On-line Forms and Publications A - D
    AD 898 (1 11) - Consent Of CDSS Or Delegated County Adoption Agency - Independent Adoptions Program AD 899 (3 08) - Statement of Understanding - Mother or a Presumed Father of the Indian Child Who is Not Detained, a Juvenile Court Dependent in Out-of-home Care, or a Ward of a Legal Guardian
  • In Home Supportive Services - California Dept. of Social Services
    The In-Home Supportive Services (IHSS) program provides in-home assistance to eligible aged, blind, and disabled individuals as an alternative to out-of-home care and enables recipients to remain safely in their own homes
  • Home | California Dept. of Social Services
    CDSS Roadmap for Facility Licensing The Community Care Licensing Division (CCLD) has step-by-step resources to guide applicants through the licensing process Help is available for Adult and Senior Care Program [PDF], Child Care Program, Children’s Residential Program [PDF], and Home Care Services applicants
  • LiveScan - California Dept. of Social Services
    Individuals can obtain a Request for Live Scan form LIC 9163 or from any local Community Care Licensing Division office This form will automatically request a Child Abuse Central Index (CACI) check if needed For Home Care Organizations and Home Care Aides, a hard copy Live Scan Submission form may be obtained by contacting the Home Care Services Branch at (916) 657-3570 or by email at hcsb
  • LIC 602A (4 25) Medical Assessment for Residential Care Facilities for . . .
    MEDICAL ASSESSMENT FOR RESIDENTIAL CARE FACILITIES FOR THE ELDERLY NOTE TO LICENSED MEDICAL PROFESSIONAL: The person patient named below is either a prospective resident or resident of a Residential Care Facility for the Elderly (RCFE) licensed by the Department of Social Services The licensee is required to provide primarily non-medical care and supervision to meet the needs of that person





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