Providers

• Locked and Secure Medication stored at facility (includes medication for permissible medical services, if applicable)
• Functioning Carbon Monoxide Detector, Smoke Alarm(s) Fire Extinguisher
• Most often used licensing forms related to family childcare (not required unless applicable)

Family Child Care Licensing Application and Instructions

• English: Family Child Care Licensing Application and Instructions

• Spanish: Family Child Care Licensing Application and Instructions

LIC 279 – Application for Family Child Care License (required if making changes to license)

• English: LIC 279 – Application for Family Child Care License (required if making changes to license)

• Spanish: LIC 279 – Application for Family Child Care License (required if making changes to license)

• Chinese: LIC 279 – Application for Family Child Care License (required if making changes to license)

LIC 9280 – Pre-licensing Checklist

• English: LIC 9280 – Pre-licensing Checklist​

• Spanish: LIC 9280 – Pre-licensing Checklist​

LIC 9121 – Facility Visit Checklist (what licensing program analyst LPA is looking for)

• English: LIC 9121 – Facility Visit Checklist (what licensing program analyst LPA is looking for)

LIC 857 – Children’s Record Review

• English: LIC 857 – Children’s Record Review​

• Spanish: LIC 857 – Children’s Record Review​

• Chinese: LIC 857 – Children’s Record Review​

LIC 9151 – Landlord Notification of Family Child Care (not consent)

• English: LIC 9151 – Landlord Notification of Family Child Care (not consent)

• Spanish: LIC 9151 – Landlord Notification of Family Child Care (not consent)

• Chinese: LIC 9151 – Landlord Notification of Family Child Care (not consent)

LIC 624B – Unusual Incident Report form

• English: LIC 624B – Unusual Incident Report form

• Spanish: LIC 624B – Unusual Incident Report form

• Chinese: LIC 624B – Unusual Incident Report form

LIC 9149 – Landlord Consent for Additional Children in Care (more than 6)

• English: LIC 9149 – Landlord Consent for Additional Children in Care (more than 6)

• Spanish: LIC 9149 – Landlord Consent for Additional Children in Care (more than 6)

• Chinese: LIC 9149 – Landlord Consent for Additional Children in Care (more than 6)

LIC 9163 – Request for LIVESAN Service

• English: LIC 9163 – Request for LIVESAN Service

• Spanish: LIC 9163 – Request for LIVESAN Service

• Chinese: LIC 9163 – Request for LIVESAN Service