Under the California Public Records Act, the Department may have to provide copies of some of the records in the file to members of the public who ask for them, including newspaper and television reporters.

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.

Applicant: If you intend to use Guardian, please start this process at the Guardian Applicant site (https://guardian.dss.ca.gov/Applicant). Working with your Facility/Organization, you will be able to retrieve a prepopulated Live Scan form which helps ensure accuracy and reduce possible delays. PO BOX 94244 Mail Station T9-15-62 N/A.

LIC 9163 – Request for Live Scan Service – This form is used by the applicant to submit their fingerprints to the Department of Justice for processing. The applicant submits a copy to ACB with the initial administrator application.

EQUEST FOR Applicant Submission ORI: A0448 Working Title: (Check one) Adult Resident other than Client Employee License, Certification, Applicant om list on Page 2, “DOJ Abbreviated C Family Day Care Agency Address Set Contributing Agency:

Instructions for the LIC 9163 Originating Response Indicator (ORI): Enter the CCLD or TrustLine ORI code below that pertains to you. Select one of the following: For CCLD applicants, check: For TrustLine applicants, check: A0448 A1157 Type of Application: Check the appropriate box.

View, download and print fillable Lic 9163 - Request For Live Scan Service - Community Care Licensing in PDF format online. Browse 2 Community Care Licensing Forms And Templates collected for any of your needs.

The Department must also tell people who ask the name of a licensed facility/organization that has a licensee, employee, resident, or other person with a criminal record exemption. If you have any questions about this form, please contact your …