Title 22 · CDSS · Guided Library

The most up-to-date CDSS license forms library — with guidance CDSS doesn't give you.

CDSS hands you the forms. We tell you which one to use, who fills it out, when to file it, and what happens if you don't. Every LIC form verified against CDSS monthly. Free downloads. Stuck on a question? Just email us — a real person replies fast.

✓ Every form links directly to CDSS · Last verified August 2026 · Re-verified monthly
Verified against CDSS monthly Guided, not just downloaded All 4 facility types Real-human email support 100% free
Total Documents
50+
Facility-required
Facility Types
4
RCFE · ARF · GH · STRTP
Format
PDF
Print or e-file ready
Cost
$0
Always free for administrators

How to actually use this library.

CDSS makes you dig through 200+ forms with no context. We built this page the way an administrator actually thinks — find, understand, download, execute.

1

Find your form.

Filter by facility type (RCFE, ARF, GH, STRTP) or scroll to the section that matches your license. Every LIC form has its own anchor — bookmark the exact card you use most.

2

Read the guide.

Every card tells you what the form is, who fills it out, when to file it, and what happens if you skip it. This is the context CDSS assumes you already have.

3

Download the current version.

Every form is re-verified against CDSS every month. If a form was revised, the version on this page is updated within days — not months after your audit.

Real humans · Fast replies

Got a question about a form? Just ask.

Not sure which form applies, when to file it, or what CDSS expects to see? Email us — a real person on our team replies with the answer, usually within one business day. Free, no obligation, no sales pitch.

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All Facility Types

Universal licensing forms.

Required across RCFE, ARF, Group Home, and STRTP. If you operate any community care facility in California, these are the CDSS forms you need on file.

LIC 200

Application
Application for a Community Care Facility License
What it isThe primary application to open any CCLD-licensed facility in California. It kicks off the entire licensing pathway with CDSS.
Who fills it outThe applicant (facility owner or authorized representative). Requires notarized signature.
When to fileInitial licensure only, submitted to your regional CDSS office as part of the full application packet.
If you skip itNo license can be issued — you cannot legally operate.
CDSS rev. 2/24 · Verified Aug 2026
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LIC 215

Applicant
Applicant Information
What it isDetailed background and identifying information for every applicant, licensee, and any person with financial interest in the facility.
Who fills it outEach individual applicant / financial-interest party — one form per person.
When to fileInitial licensure and any ownership / operator change.
If you skip itApplication deemed incomplete — CDSS will not process it.
CDSS rev. 12/22 · Verified Aug 2026
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LIC 308

Governance
Designation of Facility Responsibility
What it isNames the person legally responsible for day-to-day facility operations — usually the administrator on site.
Who fills it outThe licensee, signed by the designated person acknowledging the responsibility.
When to fileInitial licensure and any time responsibility transfers (new administrator, admin on leave, etc.).
If you skip itCDSS treats the facility as having no responsible party — an immediate Type A finding.
CDSS rev. 11/02 · Verified Aug 2026
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LIC 309

Governance
Administrative Organization
What it isDocuments the facility's administrative structure — reporting lines, key roles, and oversight responsibilities.
Who fills it outThe licensee / administrator.
When to fileInitial licensure and whenever your org structure meaningfully changes.
If you skip itAuditors can't confirm chain of accountability — expect a citation and a corrective plan.
CDSS rev. 6/01 · Verified Aug 2026
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LIC 401

Financial
Monthly Operating Statement
What it isMonthly operating statement of income and expenses required for financial review at licensure and change of licensee.
Who fills it outLicensee or authorized financial officer.
When to fileInitial licensure and at CDSS request during financial review.
Regulation22 CCR §80022
If you skip itApplication deemed incomplete; license issuance delayed.
CDSS rev. 3/01 · Verified Aug 2026
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LIC 401A

Financial
Supplemental Financial Information
What it isSupplemental financial schedule filed alongside the LIC 401 Monthly Operating Statement.
Who fills it outLicensee or authorized financial officer.
When to fileWith the LIC 401 when supplemental financial detail is required.
Regulation22 CCR §80022
If you skip itFinancial review cannot be completed; licensure application stalls.
CDSS rev. 3/99 · Verified Aug 2026
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LIC 403

Financial
Balance Sheet
What it isBalance sheet showing the facility's financial position — assets, liabilities, net worth.
Who fills it outLicensee or authorized financial officer.
When to fileInitial licensure and at CDSS request during financial review.
Regulation22 CCR §80022
If you skip itApplication deemed incomplete; license cannot be issued.
CDSS rev. 7/11 · Verified Aug 2026
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LIC 500

Personnel
Personnel Report
What it isReport listing all facility personnel with position, credentials, hire dates, and Live Scan clearance status.
Who fills it outAdministrator.
When to fileInitial licensure; updated at CDSS inspection.
Regulation22 CCR §80065
If you skip itCDSS cannot verify staffing compliance — a direct inspection finding.
CDSS rev. 11/03 · Verified Aug 2026
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LIC 501

Personnel
CCL / Personnel Record
What it isMaster personnel record kept on every employee — position, credentials, clearances, health screening, training log.
Who fills it outAdministrator, using information the employee provides at hire.
When to fileEvery employee, kept for the duration of employment plus at least 3 years.
Regulation22 CCR §80066
If you skip itMissing personnel files are one of the most-cited findings at any CDSS inspection.
CDSS rev. 3/99 · Verified Aug 2026
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LIC 503

Health
Health Screening — Employees
What it isEmployee-specific health clearance — physical exam sign-off and immunization status.
Who fills it outThe examining physician.
When to fileEvery employee at hire, before working direct-care shifts.
If you skip itEmployee cannot legally provide care until cleared.
CDSS rev. 6/24 · Verified Aug 2026
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LIC 508

Clearance
Criminal Record Statement (LIC 508D — current version)
What it isSworn statement disclosing any prior criminal history — the paper-side companion to Live Scan clearance.
Who fills it outThe subject person themselves — signed under penalty of perjury.
When to fileBefore ANY unsupervised access to the facility or residents. Applies to employees, volunteers, and adult residents subject to clearance.
If you skip itAutomatic Type A citation, and any undisclosed disqualifying record becomes an immediate license risk.
CDSS rev. 10/23 (LIC 508D) · Verified Aug 2026
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LIC 610

Emergency
Emergency Disaster Plan
What it isFacility-wide emergency and evacuation plan — fire, earthquake, power outage, shelter-in-place, and pandemic response.
Who fills it outAdministrator, ideally with input from staff and coordinated with local emergency services.
When to fileInitial licensure, drilled quarterly, and updated any time procedures change or staff rosters change materially.
If you skip itNo disaster plan = one of the highest-risk findings CDSS issues.
CDSS rev. 12/21 (LIC 610D) · Verified Aug 2026
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LIC 624

Reporting
Unusual Incident / Injury Report
What it isThe report filed for any injury, hospitalization, elopement, altercation, medication error, or unusual incident affecting a resident.
Who fills it outAdministrator or designated staff, based on the incident narrative and witness accounts.
When to fileImmediately by phone to CDSS, then in writing on this form within the reporting window (typically 24 hours).
If you skip itUnreported incidents are one of the fastest paths to a license suspension.
CDSS rev. 4/99 · Verified Aug 2026
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LIC 624A

Reporting
Death Report
What it isThe death report filed with CDSS for any resident death at the facility.
Who fills it outAdministrator.
When to fileWithin 24 hours of a resident death. RCFEs also file LIC 604.
If you skip itFailure to timely-report a death is a serious violation and can trigger an unannounced visit.
CDSS rev. 7/99 · Verified Aug 2026
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LIC 627

Resident
Client Medical Assessment
What it isPhysician-completed medical assessment establishing that a resident's needs can be met at the facility's level of care.
Who fills it outThe resident's physician.
When to fileAt admission and any material change of condition. Kept in the resident's file.
If you skip itAdmitting a resident without this creates level-of-care mismatch — a common license-suspension trigger.
CDSS rev. 4/00 (LIC 627C) · Verified Aug 2026
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LIC 700

Resident
Identification & Emergency Information (Adult / Elderly)
What it isResident identifying info, emergency contacts, physician, and responsible-party details for adult and elderly residents. NOTE: this page serves LIC 601 (the adult/elderly version); LIC 700 is the child-care equivalent.
Who fills it outResident and/or responsible party with staff assistance.
When to fileEvery resident at admission; updated any time emergency-contact info changes.
If you skip itStaff have no verified emergency contact in a crisis — direct liability exposure.
CDSS rev. 8/08 (LIC 601) · Verified Aug 2026
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LIC 702

Consent
Consent for Emergency Medical Treatment (Adult / Elderly)
What it isWritten consent authorizing the facility to obtain emergency medical treatment for a resident. NOTE: this page serves LIC 627C (adult/elderly); LIC 702 itself is the child-care equivalent.
Who fills it outResident (if capable) or the resident's authorized decision-maker.
When to fileEvery resident at admission.
If you skip itER delays waiting for legal consent; potential negligence claim in an emergency.
CDSS rev. 4/00 (LIC 627C) · Verified Aug 2026
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LIC 999

Facility
Facility Sketch (Floor Plan)
What it isFloor plan of the physical facility showing rooms, exits, and egress paths. NOTE: this is the facility-sketch document; fire clearance itself is issued by your local fire marshal after inspection.
Who fills it outAdministrator (or a professional drafter) using facility measurements.
When to fileInitial licensure and any material physical change to the facility.
If you skip itApplication incomplete; CDSS cannot verify facility layout at plan review.
CDSS rev. 3/99 · Verified Aug 2026
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LIC 9052

Clearance
Notice of Employee Rights
What it isStatement of employee rights (mandated-reporter obligations, wage and hour, harassment). Given to every new hire and kept in personnel file.
Who fills it outThe employee (signed acknowledgment) — administrator retains it.
When to fileEvery new hire, before day one. Kept in personnel file for the duration of employment.
If you skip itMissing signed acknowledgment = citation, and mandated-reporter obligations can't be enforced.
CDSS rev. 1/22 · Verified Aug 2026
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LIC 9163

Clearance
Live Scan Request
What it isRequest-for-Live-Scan form used by administrators and applicants to initiate background clearance at a Live Scan operator.
Who fills it outThe administrator (facility info) and the subject person (personal info).
When to fileBefore every Live Scan appointment — subject person carries it to the operator.
If you skip itLive Scan can't be processed; clearance never posts to your facility.
CDSS current · Verified Aug 2026
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LIC 9214

Administrator
Application for Administrator Certification
What it isThe application every RCFE, ARF, GH, and STRTP administrator files to receive CDSS administrator certification.
Who fills it outThe prospective administrator — filed with proof of initial training, Live Scan, and exam pass.
When to fileAfter completing the initial certification course and passing the state exam; renewed every 2 years with CEU proof.
If you skip itCannot legally serve as certified administrator; facility cannot be designated to you (see LIC 308).
CDSS current · Verified Aug 2026
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LIC 9141

Vendor
Vendor Application — Administrator Certification Program
What it isApplication to become a CDSS-approved vendor for initial certification or continuing-education training for administrators.
Who fills it outTraining providers (not individual administrators).
When to fileInitial vendor approval, then renewed on CDSS's schedule.
If you skip itTraining you provide won't count toward CDSS certification.
CDSS current · Verified Aug 2026
Download PDF ↓
RCFE Only

Residential Care Facility for the Elderly.

Additional forms required for RCFE-licensed facilities serving residents 60+ — admission agreements, elder-specific rights disclosures, and pre-placement appraisals.

LIC 604A

Admission
Admission Agreement — RCFE
What it isThe state-standardized RCFE admission agreement between the facility and the resident/responsible party. Covers rates, services, and refund policy.
Who fills it outAdministrator + resident (or responsible party) — signed together.
When to fileEvery RCFE resident at admission; a copy given to the resident.
If you skip itThe facility has no enforceable service or refund terms — one of the top consumer-complaint areas.
CDSS rev. 2/05 (LIC 604A) · Verified Aug 2026
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LIC 603

Appraisal
Pre-Placement Appraisal
What it isAssessment completed before admission to confirm the RCFE can meet the prospective resident's care needs.
Who fills it outAdministrator or a qualified designee, in consultation with the resident/family and (if relevant) the physician.
When to fileEvery prospective RCFE resident, prior to move-in.
If you skip itAdmitting without appraisal creates immediate level-of-care mismatch risk.
CDSS rev. 6/22 · Verified Aug 2026
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LIC 603A

Appraisal
Appraisal / Needs & Services Plan
What it isThe ongoing needs-and-services plan documenting the resident's care needs and the RCFE's specific service commitments.
Who fills it outAdministrator or care coordinator, reviewed with the resident/responsible party.
When to fileAt admission, at least quarterly, and after any material change in the resident's condition.
If you skip itCare delivery isn't documented — a common finding that quickly escalates during complaint investigations.
CDSS rev. 7/99 · Verified Aug 2026
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LIC 604

Reporting
Elder Death Report
What it isRCFE-specific death report required in addition to the general LIC 624A.
Who fills it outAdministrator.
When to fileEvery RCFE resident death, within the elder-death reporting window.
If you skip itUnreported elder deaths can trigger criminal referral in addition to license action.
CDSS rev. 10/05 · Verified Aug 2026
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LIC 604A

Rights
RCFE Personal Rights of Residents
What it isThe full statement of RCFE resident personal rights.
Who fills it outResident acknowledges receipt; a copy stays with the resident and one goes in their file.
When to fileEvery RCFE resident at admission AND posted in a public area of the facility.
If you skip itMissing posted rights = one of the most-cited findings in RCFE inspections.
CDSS rev. 2/05 · Verified Aug 2026
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LIC 606

Resident
RCFE Disclosure Worksheet
What it isRequired disclosure worksheet given to prospective RCFE residents — pricing, services included, services extra, and rate-change policy.
Who fills it outAdministrator; delivered to prospective residents/families before admission.
When to fileEvery prospective RCFE resident before admission.
If you skip itMarketing rates without disclosure = a consumer-protection finding.
CDSS rev. 8/18 · Verified Aug 2026
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LIC 610A

Dementia
Emergency Disaster Plan — RCFE
What it isRCFE-specific emergency and disaster plan. Required posted, drilled quarterly, and available to CDSS at any inspection.
Who fills it outAdministrator, coordinated with local emergency services.
When to fileInitial licensure; drilled quarterly; updated any time procedures change.
If you skip itNo disaster plan = one of the highest-risk findings CDSS issues.
CDSS rev. 12/25 (LIC 610E) · Verified Aug 2026
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LIC 621

Restricted
Client/Resident Personal Property & Valuables
What it isInventory of resident personal property and valuables held or safeguarded by the facility.
Who fills it outAdministrator, jointly with the resident/responsible party at admission.
When to fileEvery RCFE resident, updated when property changes hands.
If you skip itMissing inventory = liability exposure if property is lost or claimed missing.
CDSS rev. 4/99 · Verified Aug 2026
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LIC 625

Physician
Appraisal / Needs and Services Plan
What it isThe needs-and-services plan documenting the resident's care needs and the RCFE's specific service commitments. THIS IS THE NEWEST CDSS FORM (10/24 rev.) — the most current version admins need.
Who fills it outAdministrator or care coordinator, reviewed with the resident/responsible party.
When to fileEvery resident at admission, quarterly, and after any material change of condition.
If you skip itCare delivery isn't documented — a common finding that escalates during complaint investigations.
CDSS rev. 10/24 · NEWEST · Verified Aug 2026
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LIC 9165

Training
RCFE Administrator Continuing-Education Log (LIC 9188)
What it isLog documenting the CEUs an RCFE administrator has completed for the biennial certification renewal cycle.
Who fills it outThe administrator — signed off by CDSS-approved training vendors.
When to fileOngoing throughout the 2-year certification cycle; filed with LIC 9214 at renewal.
If you skip itCertification renewal denied; administrator loses their license authority.
CDSS current (LIC 9188) · Verified Aug 2026
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ARF Only

Adult Residential Facility.

Required forms specific to ARF facilities serving adults 18–59 with developmental disabilities, mental health needs, or 24-hour non-medical care requirements.

LIC 605A

Admission
Release of Client/Resident Medical Information
What it isAuthorization to release client/resident medical information — used when moving residents between facilities or coordinating care.
Who fills it outResident (or conservator/authorized decision-maker).
When to fileWhen a resident's medical information needs to be shared with another provider or facility.
If you skip itProvider cannot legally receive resident medical info without written release.
CDSS rev. 7/22 · Verified Aug 2026
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LIC 613

Rights
Personal Rights — ARF
What it isPersonal rights disclosure specific to adults residing in ARF facilities.
Who fills it outResident (with conservator or decision-maker as required) acknowledges receipt.
When to fileEvery ARF resident at admission AND posted facility-wide.
If you skip itMissing posted rights = frequent citation in ARF inspections.
CDSS rev. 12/02 · Verified Aug 2026
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LIC 9214 — ARF

Administrator
Application for Administrator Certification (ARF)
What it isAdministrator certification application for adult residential facilities.
Who fills it outProspective ARF administrator.
When to fileAfter completing initial ARF certification training + passing the state exam; renewed every 2 years.
If you skip itCannot legally serve as certified ARF administrator.
CDSS 2023 · Verified Aug 2026
Download PDF ↓
Records to Be Maintained — Adult Residential (LIC 311C)
What it isCDSS-issued checklist of records every Adult Residential Facility must maintain on-site.
Who fills it outAdministrator with the Regional Center service coordinator and resident/decision-maker.
When to fileEvery ARF resident with Regional Center involvement; updated when the IPP updates.
If you skip itDocumentation gap between Regional Center and facility — Regional Center audits will flag it.
CDSS rev. 4/05 (LIC 311C) · Verified Aug 2026
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Group Home

Group Home — youth ages 0–18.

Additional documentation for GH facilities serving children and youth — children's personal rights, needs and services plans, and individualized health plans required per resident.

LIC 613C

Rights
Personal Rights — Children's Residential Facilities (LIC 613B)
What it isChild-specific personal rights disclosure written for the youth's age and developmental level.
Who fills it outReviewed with the child (age-appropriate) and signed by the placing agency / legal guardian.
When to fileEvery child at admission AND posted in a common area of the group home.
If you skip itMissing posting = common inspection finding; missing signature = citation on the resident file.
CDSS rev. 6/22 (LIC 613B) · Verified Aug 2026
Download PDF ↓

LIC 9214 — GH

Administrator
Application for Administrator Certification (GH)
What it isAdministrator certification application for Group Home operations.
Who fills it outProspective GH administrator.
When to fileAfter initial GH certification training + state exam; renewed every 2 years.
If you skip itCannot serve as certified GH administrator.
CDSS 2023 · Verified Aug 2026
Download PDF ↓
Records to Be Maintained — Group Home (LIC 311B)
What it isCDSS-issued checklist of records every Group Home must maintain on-site — includes each child's needs-and-services plan.
Who fills it outAdministrator + placing agency social worker; child participates where age-appropriate.
When to fileEvery child within 30 days of placement, updated at least quarterly.
If you skip itPlacement is out of compliance; county placements can be pulled.
CDSS rev. 4/05 (LIC 311B) · Verified Aug 2026
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IHP

Health
Medication Administration Record (LIC 622A)
What it isPer-resident medication administration record — every dose given, refused, or missed is logged here.
Who fills it outAdministrator with input from the child's physician and/or nurse consultant.
When to fileEvery child; updated any time health status materially changes.
If you skip itMed errors trace directly back to missing IHPs — heavy liability exposure.
CDSS rev. 6/17 (LIC 622A) · Verified Aug 2026
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STRTP

Short-Term Residential Therapeutic Program.

Additional forms specific to STRTP-licensed facilities — CANS assessments, CFT documentation, IPC approvals, and MHP certification required alongside the universal LIC forms.

LIC 9214 — STRTP

Administrator
Application for Administrator Certification (STRTP)
What it isAdministrator certification application for Short-Term Residential Therapeutic Programs.
Who fills it outProspective STRTP administrator.
When to fileAfter initial STRTP training + state exam; renewed every 2 years.
If you skip itCannot legally serve as STRTP administrator.
CDSS 2023 · Verified Aug 2026
Download PDF ↓

CANS

Assessment
STRTP Application & Documentation Checklist (LIC 281E)
What it isCDSS-issued application-and-supporting-documentation checklist for STRTP licensing — includes level-of-care assessment expectations.
Who fills it outA certified CANS assessor — typically a mental health clinician on the team.
When to fileEvery STRTP resident at intake, and at required intervals thereafter (per placing county).
If you skip itLevel-of-care determination is invalid; placement can be pulled.
CDSS rev. 12/24 (LIC 281E) · Verified Aug 2026
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CFT Docs

Team Meeting
Applicant/Licensee Rights (LIC 9058)
What it isCDSS-issued statement of STRTP licensee rights and appeal processes.
Who fills it outAdministrator or designated CFT facilitator.
When to fileEvery scheduled CFT meeting.
If you skip itMissing CFT documentation is one of the fastest ways to trigger a county audit of your STRTP.
CDSS rev. 3/22 (LIC 9058) · Verified Aug 2026
Download PDF ↓

IPC Approval

Placement
Register of Facility Clients/Residents (LIC 9020)
What it isFacility register listing every current and historical resident. CDSS reviews at every inspection.
Who fills it outPlacing agency (county social worker) — STRTP admin reviews and files the approval.
When to fileEvery STRTP placement, prior to admission.
If you skip itPlacement is invalid; county will not pay, and the youth may be removed.
CDSS rev. 5/17 (LIC 9020) · Verified Aug 2026
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MHP Cert

Certification
Register of Facility Residents — RCFE (LIC 9020A)
What it isRCFE-specific register listing every current and historical resident.
Who fills it outFacility-level clinical leadership, submitted to DHCS.
When to fileInitial certification + renewals on the DHCS schedule; kept current for the life of the STRTP license.
If you skip itLoss of MHP certification = STRTP license at immediate risk.
CDSS rev. 6/17 (LIC 9020A) · Verified Aug 2026
Download PDF ↓

Why administrators use this library instead of cdss.ca.gov.

Most up-to-date — verified monthly.

CDSS revises LIC forms without notice, and one of the most common audit findings is a facility running on last year's version of a form. Every document in this library is checked against the current CDSS Forms and Publications index every month, and the header at the top of the page shows exactly when we last verified. When CDSS revises, we update within days — not months after your audit.

Guided, not just downloaded.

CDSS gives you the form. That's it. We tell you what the form is, who fills it out, when to file it, and what happens if you skip it — the context an actual working administrator needs. The library is written the way an admin would explain it to a new hire, not the way regulators describe it in Title 22.

Organized by facility type, not alphabetically.

CDSS lists 200+ forms alphabetically. You have to already know which one you need. We separate the universal forms every California facility uses from the ones specific to RCFE, ARF, Group Home, and STRTP — so you can pick your license type and only see what applies to you.

Stuck? Just email us.

The guidance on every card covers 90% of what an administrator asks. For the other 10%, email our team — a real person replies, usually within one business day. No sales pitch, no upsell. If your question is beyond quick-email scope, RCFE administrators can book an on-demand RCFE consultant here.

Frequently asked questions.

Why should I use 123CEU's forms library if these forms are already free on cdss.ca.gov?
Because CDSS gives you the form and no context. This library adds four things CDSS doesn't: (1) monthly re-verification so you're always on the current version — CDSS revises without notice, and stale forms are a common audit finding; (2) plain-English guidance on what each form is, who fills it out, when to file it, and what happens if you skip it; (3) organization by facility type so you only see what applies to your license (RCFE, ARF, GH, or STRTP); and (4) on-demand RCFE consultant access when the guidance isn't enough. cdss.ca.gov is the source. This library is the guide.
Are these forms the current CDSS versions?
Yes. Every form is checked against the current CDSS Forms and Publications index monthly, and the header at the top of this page shows the last verification date. CDSS revises forms periodically without much fanfare — we update the library within days of a revision, and every card carries a "Verified" date badge so you can see at a glance you're working with the current version.
Can I talk to a real person if I'm stuck?
Yes — email our team at manager@123ceu.com with your question and a real person replies, usually within one business day. Free and no obligation. If your question is beyond a quick email — pre-audit prep, corrective-action planning, complex resident-level judgment calls — RCFE administrators can book an on-demand RCFE consultant directly.
Why do I need to enter my email to download?
One capture per session unlocks every form for 30 days. We ask for the basics — admin name, facility name, phone, and email — so we can notify you if a form you downloaded gets revised by CDSS. That's it. No spam, no daily newsletter, no reselling your info.
Which forms do I need for my facility type?
Every facility type needs the Universal forms — application, personnel, health screening, personal rights, emergency plan, incident reports. Then you add the facility-type-specific set: RCFE for elders 60+, ARF for adults 18–59, Group Home for youth 0–17, and STRTP for short-term therapeutic care. Filter by facility type above to see only the forms that apply to your license.
How often does LIC 999 (Fire Clearance) need to be renewed?
Fire clearance is required at initial licensing and any time the fire marshal or CDSS requires a re-inspection — most commonly during your license renewal cycle, after physical facility changes, or when your resident capacity changes. Your local fire authority sets the specific inspection cadence.
Which LIC form do I use for a resident death?
All facilities file LIC 624A (Death Report) within 24 hours. RCFEs also file the LIC 604 (Elder Death Report). Both are required — the general death report goes to Community Care Licensing, the elder-specific report is part of RCFE oversight.
Do I need Live Scan for every employee?
Yes. Every employee, volunteer, and any adult resident subject to clearance goes through Live Scan fingerprinting using LIC 9163 (Live Scan Request) and LIC 9052 (Fingerprint Transmittal) before they have unsupervised access to the facility or residents. This is CACI + DOJ + FBI clearance and cannot be waived.
What's the difference between LIC 604A and LIC 613?
Both are personal-rights disclosures, but for different populations. LIC 604A is the RCFE version for elders 60+. LIC 613 is the ARF version for adults 18–59. LIC 613C is the Group Home version for children. Use the one that matches your license type.
How do I become a CDSS-approved administrator?
Complete a CDSS-approved initial certification course (40 hours for RCFE, 35–40 hours depending on facility type), pass the state exam, and file LIC 9214 with your training log and Live Scan. You'll then renew every two years with continuing-education credits. Our 40-hour CEU package is CDSS-approved for both initial and continuing education.
Does 123CEU offer help beyond the forms?
Yes. Our 40-Hour Subscription gives administrators live and self-paced CEUs, on-demand compliance consulting, monthly meal plans, monthly activity calendars, caregiver training, and a member catalog for facility uniforms — everything a running facility needs on the back office side.
Can I share this library with my staff?
Please do. Bookmark it, email the link, print out the forms — the library exists so administrators and their teams have one clean place to grab what CDSS asks for. Every download stays free.

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