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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 October 2026 · Re-verified monthly
✓ Verified against CDSS monthly
✓ Guided, not just downloaded
✓ All 4 facility types
✓ Real-human email support
✓ 100% free
Total Documents
42
CDSS LIC forms
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. Want a heads-up when one of yours changes? Join Form Watch.
Revision alerts · Free · Checked monthly
Form Watch: never get cited for an outdated form.
CDSS revises LIC forms without notice, and running an outdated version is one of the most common audit findings. We check every form in this library against CDSS every month. Form Watch tells you when one of yours changes.
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For any administrator, any facility type.
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Each button opens your email app with a short sign-up form already filled in. Fill in the blanks and hit send, and a real person on our team adds you, usually within one business day. No spam, no daily newsletter, we never sell your info. You never need to sign up to download a form: every form stays free and one click from CDSS.
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Question beyond a quick email? RCFE administrators can book an on-demand RCFE consultant here →
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
ApplicationApplication 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 Oct 2026
LIC 215
ApplicantApplicant 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 Oct 2026
LIC 308
GovernanceDesignation 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 Oct 2026
LIC 309
GovernanceAdministrative 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 Oct 2026
LIC 401
FinancialMonthly 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 Oct 2026
LIC 401A
FinancialSupplemental 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 Oct 2026
LIC 403
FinancialBalance 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 Oct 2026
LIC 500
PersonnelPersonnel 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 Oct 2026
LIC 501
PersonnelCCL / 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 Oct 2026
LIC 503
HealthHealth Screening Report — Facility Personnel
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 Oct 2026
LIC 508D
ClearanceOut-of-State Disclosure & Criminal Record Statement
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 · Verified Oct 2026
LIC 610D
EmergencyEmergency Disaster Plan — Adult Residential & Other Adult Facilities
What it isFacility-wide emergency and evacuation plan — fire, earthquake, power outage, shelter-in-place, and pandemic response. This is the adult-facility version (ARF and similar); RCFEs use LIC 610E in the RCFE section.
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 · Verified Oct 2026
LIC 624
ReportingUnusual 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 fileReport to your licensing office by phone or fax by the next working day, then submit this written report within 7 days. Suspected abuse of an elder or dependent adult has shorter deadlines: 2 hours if serious bodily injury, 24 hours otherwise.
If you skip itUnreported incidents are one of the fastest paths to a citation, a complaint investigation, or license action.
CDSS rev. 4/99 · Verified Oct 2026
LIC 624A
ReportingDeath Report
What it isThe death report filed with CDSS for any resident death at the facility.
Who fills it outAdministrator.
When to fileReport the death to your licensing office by the next working day, then submit the written report within 7 days.
If you skip itFailure to timely-report a death is a serious violation and can trigger an unannounced visit.
CDSS rev. 7/99 · Verified Oct 2026
LIC 602
MedicalPhysician's Report for Community Care Facilities
What it isPhysician-completed medical report establishing that a client's needs can be met at the facility's level of care — diagnoses, TB results, medications, and ambulatory status. RCFEs use LIC 602A in the RCFE section.
Who fills it outThe client's physician.
When to fileBefore admission and after any material change of condition. Kept in the client's file.
If you skip itAdmitting a client without it creates a level-of-care mismatch — a common citation and license-risk trigger.
CDSS rev. 7/22 · Verified Oct 2026
LIC 601
ResidentIdentification & Emergency Information
What it isResident identifying information, emergency contacts, physician, and responsible-party details.
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 · Verified Oct 2026
LIC 627C
ConsentConsent for Emergency Medical Treatment — Adult & Elderly
What it isWritten consent authorizing the facility to obtain emergency medical treatment for a resident. This is the adult and elderly version; children's residential facilities use LIC 627B.
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 · Verified Oct 2026
LIC 999
FacilityFacility 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 Oct 2026
LIC 9052
PersonnelNotice: Employee Rights
What it isCDSS notice telling employees they have the right to file a licensing complaint against their employer without retaliation. The employee signs and returns the tear-off acknowledgment. The form cites child-care statutes (HSC 1596.881), so confirm with your regional office whether it's required for your license type.
Who fills it outThe employee signs the acknowledgment; the administrator keeps it.
When to fileAt hire. Keep the signed acknowledgment in the personnel file.
If you skip itMissing signed acknowledgment where the notice is required = a personnel-file citation.
CDSS rev. 1/22 · Verified Oct 2026
LIC 9163
ClearanceRequest for Live Scan Service
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 rev. 11/25 · Verified Oct 2026
LIC 9214
AdministratorApplication for Administrator Certification
What it isThe application every RCFE, ARF, GH, and STRTP administrator files for initial certification and for each two-year renewal.
Who fills it outThe administrator. Initial applicants file with proof of initial training, the state exam, and Live Scan; renewals file with CEU certificates.
When to fileInitial: after the initial certification course (RCFE 80 hours, up to 20 self-paced; ARF 35; GH 40; STRTP 40) and the state exam. Renewal: every 2 years after 40 CEU hours (at least 20 live), submitted no more than 90 days before expiration.
If you skip itYou can't serve as a certified administrator, and a late renewal adds a $300 delinquency fee.
CDSS rev. 7/25 · Verified Oct 2026
LIC 9141
VendorVendor Application/Renewal — 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 rev. 6/23 · Verified Oct 2026
RCFE Only
Residential Care Facility for the Elderly.
Additional forms required for RCFE-licensed facilities serving residents 60+ — the admission agreement, appraisals and medical assessments, elder-specific personal rights, and the RCFE disaster plan.
LIC 604A
AdmissionAdmission 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 · Verified Oct 2026
LIC 603
AppraisalPreplacement Appraisal Information
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 Oct 2026
LIC 603A
AppraisalResident Appraisal — RCFE
What it isRCFE resident appraisal covering overall health, physical limitations, mental condition, and social participation. It does not replace the medical assessment (LIC 602A).
Who fills it outAdministrator or designee, using information from the prospective resident or their responsible person.
When to fileBefore admission as part of the pre-admission appraisal, and again when the resident's condition changes.
If you skip itAdmitting without a documented appraisal creates level-of-care risk and a resident-file citation.
CDSS rev. 7/99 · Verified Oct 2026
LIC 602A
MedicalMedical Assessment for RCFEs
What it isMedical assessment signed by a licensed medical professional — TB and other conditions, current medications, ambulatory status, and cognitive conditions. Revised 4/26.
Who fills it outA licensed medical professional (physician, NP, or PA acting within scope).
When to fileBefore accepting a resident (assessment made within the last year), and again when CDSS requires an update.
Regulation22 CCR §87458
If you skip itAccepting a resident without it = a citation and a level-of-care risk.
CDSS rev. 4/26 · Verified Oct 2026
LIC 625
AppraisalAppraisal / Needs and Services Plan
What it isThe needs-and-services plan documenting the resident's care needs and the facility's specific service commitments. The 10/24 revision is the current version.
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 · Verified Oct 2026
LIC 613C-2
RightsPersonal Rights of Residents — Privately Operated RCFEs
What it isThe full statement of personal rights for residents of privately operated RCFEs, including the nondiscrimination notice. (Publicly operated RCFEs use LIC 613C.)
Who fills it outResident acknowledges receipt; one 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 or unposted rights = one of the most-cited findings in RCFE inspections.
CDSS rev. 3/25 · Verified Oct 2026
LIC 606
ResidentRCFE 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 Oct 2026
LIC 610E
EmergencyEmergency 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 · Verified Oct 2026
LIC 621
ResidentClient/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 Oct 2026
LIC 9020A
RegisterRegister of Facility Residents — RCFE
What it isRCFE-specific register listing every current resident with ambulatory status, health conditions, physician, and responsible person.
Who fills it outAdministrator.
When to fileKept current — updated at every admission, discharge, or change in status. CDSS reviews it at inspections.
If you skip itAn incomplete register is a direct inspection finding and an emergency-response gap.
CDSS rev. 6/17 · Verified Oct 2026
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 — admission agreement, personal rights, medical release, and the records checklist.
Administrator certification for every facility type uses one form: LIC 9214 in the Universal forms ↑
LIC 604
AdmissionAdmission Agreement Guide for Residential Facilities
What it isCDSS sample admission agreement for residential community care facilities. It is a guide only: use it to build your own agreement, not as the agreement itself. RCFEs use the standardized LIC 604A.
Who fills it outAdministrator, then the client (or authorized representative) signs the agreement you build from it.
When to fileUse it when drafting or updating your admission agreement. Every client needs a signed agreement at admission.
If you skip itNo written admission agreement = a citation, and no enforceable service or refund terms.
CDSS rev. 10/05 · Verified Oct 2026
LIC 605A
MedicalRelease 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 Oct 2026
LIC 613
RightsPersonal 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 Oct 2026
LIC 311C
RecordsRecords to Be Maintained at the Facility — Adult Residential
What it isCDSS checklist of every client and facility record an ARF must keep on site, complete, and ready for review. For Regional Center clients, the IPP can stand in for the LIC 625.
Who fills it outAdministrator — use it as your records checklist.
When to fileKeep on file and audit your client and personnel files against it before every inspection.
If you skip itMissing required records = the most common type of ARF citation.
CDSS rev. 4/05 · Verified Oct 2026
Group Home
Group Home — children and youth.
Additional documentation for GH facilities serving children and youth — children's personal rights, the required-records checklist, and medication records kept for every child.
Administrator certification for every facility type uses one form: LIC 9214 in the Universal forms ↑
LIC 613B
RightsPersonal Rights — Children's Residential Facilities
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 · Verified Oct 2026
LIC 311B
RecordsRecords to Be Maintained by the Facility — Group Homes
What it isCDSS checklist of every child and facility record a Group Home must keep on site — including the LIC 603, LIC 625 needs-and-services plan, LIC 602, and LIC 613B for each child.
Who fills it outAdministrator — use it as your records checklist.
When to fileKeep on file and audit each child's file against it at placement and before every inspection.
If you skip itMissing records put placements out of compliance; counties can pull placements.
CDSS rev. 4/05 · Verified Oct 2026
LIC 622A
HealthMedication Administration Record (MAR)
What it isPer-child record of every non-psychotropic medication dose — given, refused, or missed.
Who fills it outStaff who assist with medications, with administrator oversight.
When to fileEvery child receiving medication — logged at each dose.
If you skip itMedication errors with no MAR behind them are heavy liability exposure and a direct citation.
CDSS rev. 6/17 · Verified Oct 2026
STRTP
Short-Term Residential Therapeutic Program.
Additional forms for STRTP-licensed facilities — the STRTP application checklist, your rights during licensing visits, and the facility register, used alongside the universal LIC forms.
Administrator certification for every facility type uses one form: LIC 9214 in the Universal forms ↑
LIC 281E
ApplicationApplication & Supporting Documentation Checklist — STRTP
What it isCDSS checklist of every form and document in an STRTP license application package.
Who fills it outThe applicant or licensee.
When to fileInitial application, and whenever a licensed STRTP submits revised information to CDSS.
If you skip itIncomplete packages stall — CDSS won't process the application.
CDSS rev. 12/24 · Verified Oct 2026
LIC 9058
RightsApplicant/Licensee Rights
What it isCDSS statement of your rights as an applicant or licensee during licensing visits — evaluator identification, an accurate findings report, and appeal processes. Applies to all community care licensees.
Who fills it outNo filing — the administrator keeps it on hand.
When to fileReview before any site visit, complaint visit, or plan of correction.
If you skip itYou may miss appeal windows or accept findings you had the right to contest.
CDSS rev. 3/22 · Verified Oct 2026
LIC 9020
RegisterRegister of Facility Clients/Residents
What it isFacility register listing every current client with ambulatory status, restricted health conditions, physician, and responsible person. Used by community care facilities including STRTPs.
Who fills it outAdministrator.
When to fileKept current — updated at every admission, discharge, or change in status. CDSS reviews it at inspections.
If you skip itAn incomplete register is a direct inspection finding and an emergency-response gap.
CDSS rev. 5/17 · Verified Oct 2026
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. Form Watch emails you when one of your forms changes.
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) real-human email help, plus 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.
Do I need to sign up to download a form?
No. Every download button links straight to the official PDF on cdss.ca.gov — no form, no email, no popup. If you'd like to hear when CDSS revises a form for your facility type, join Form Watch. It's free and optional.
What is Form Watch?
Form Watch is our revision-alert service. We check every form in this library against CDSS monthly. Free Form Watch sends a monthly email listing which forms changed for your facility type. Form Watch Pro — included free with every 123CEU membership — adds a priority alert as soon as a revision is confirmed, a plain-English summary of what changed, and what to do with your old version. Sign up here.
Which forms do I need for my facility type?
Every facility type needs the Universal forms — application, financial, personnel, health screening, clearance, and incident reports. Then you add the facility-type-specific set: RCFE for elders 60+, ARF for adults 18–59, Group Home for children and youth, and STRTP for short-term therapeutic care. Filter by facility type above to see only the forms that apply to your license.
Is LIC 999 the fire clearance?
No. LIC 999 is the Facility Sketch (floor plan). Fire clearance itself is issued by your local fire authority after inspection. It 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?
Use LIC 624A (Death Report). Report the death to your licensing office by the next working day, then submit the written report within 7 days. This applies to every facility type, including RCFEs, and covers a death from any cause, wherever it occurred.
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 (Request for Live Scan Service), along with the LIC 508D Criminal Record Statement, before they have unsupervised access to the facility or residents. This is DOJ and FBI clearance and cannot be waived.
Which personal rights form do I use?
It depends on your license type. LIC 613C-2 is for privately operated RCFEs (elders 60+). LIC 613 is the ARF version (adults 18–59). LIC 613B is for children's residential facilities, including Group Homes. Note that LIC 604A is the RCFE admission agreement, not a rights form.
How do I become a CDSS-approved administrator?
Complete a CDSS-approved initial certification course (80 hours for RCFE, up to 20 of them self-paced; 35 for ARF; 40 for GH and STRTP), pass the state exam, and file LIC 9214 with your Live Scan. You then renew every two years with 40 CEU hours, at least 20 of them live. Our 40-Hour Subscription covers those renewal hours with CDSS-approved courses.
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, a member catalog for facility uniforms, and Form Watch Pro revision alerts — 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.
Ready to get your certification, not just your paperwork?
The forms are free. The training that puts your certification in your hands is where 123CEU lives. Our 40-Hour Subscription covers the CEU hours you need to renew, plus on-demand compliance consulting, Form Watch Pro revision alerts, and monthly back-office deliverables built for real facilities.
See the 40-Hour Subscription →
CDSS Approved Vendor
RCFE Vendor # 2000783-740-2
STRTP Vendor # 2000783-733-2
ARF Vendor # 2000783-735-2
GH Vendor # 2000783-730-2
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