CCL Mission: To support the child care community by protecting the health and safety of children in child care programs we oversee. Welcome to the Community Care Licensing Division. Partnership agreement/Articles Of Organization. 195 North 1950 West Other forms are blank, printable forms which need to be completed offline and mailed. Swimming Provisions - BCAL-1890, Child Care Home Record Requirements - BCAL-5040, Child Care Center Record Requirements - BCAL-5041. LIC 627. Select option 2 for Provider Management. You can use the sample forms as they are or change them to meet your needs. View our employee call list. You will need to contact the local licensing office for dates and times the administrator exam is given. This is one piece of a historic $1.4 billion investment to expand access to quality, affordable child care for families. The required forms are part of rule and cannot be changed. Verification Of Administrator Qualifications & Certification. Foster Family Homes. On average this form takes 1 minutes to complete. COMMUNITY CARE LICENSING DIVISION ADVOCACY AND TECHNICAL SUPPORT RESOURCE GUIDE MEDICATIONS FOR SENIOR CARE FACILITIES TSP 2016-03 (version 09/30/2016) PAGE 4 Incidental Medical and Dental Care Services (22 CCR 87465) Scenario: Description of Regulations: Best Practices: Medications required to be centrally stored, continued 1-800-371-7897 responsiveVoice.cancel(); The Community Care Licensing (California) form is 1 page long and contains: Fill has a huge library of thousands of forms all set up to be filled in easily and signed. Group Homes. Fill is the easiest way to complete and sign PDF forms online. The Community Care Licensing (California) form is 1 page long and contains: Country of origin: US For more information regarding the complaint process, please see Provider Information Notice (PIN) Although all of the information is the same, there may be some confusion about where to find everything on our newly designed CCL Website. Licensing Forms. Crisis Line & Mobile Outreach Team We serve the most vulnerable people of California and our mission is to promote the health, safety, and quality of life of each person in community care through the administration of an effective and collaborative regulatory enforcement system. }; To get the most out of Fill, please switch to a free modern browser such as Google Chome or Safari. You're on your way to completing your first doc! Salt Lake City, Ut 84116, Child Care Licensing Contact Info Salt Lake City, UT 84116, Headquarters Spanish. Child Care Licensing Program Office 744 P Street, MS: T9-15-48 Sacramento, CA 95814 Phone (916) 651-6040 Fax (916) 651-0531 Northern Regional Offices Assistant Program Administrator, Robert Garza (916) 651-6040, Alt. The Division of Licensing and Background Checks is comprised of the Office of Licensing and the Office of Background Processing. Regional Offices Contact Information. Reducing Barriers to Licensure for Military Families, Corporations, Securities & Commercial Licensing, Find / Verify a Licensed Professional or Business, Make a Complaint About a Licensed Professional or Business, Look Up Underground Storage Tank Information, Access the Online Liquor Ordering (OLO) System, Regulated Products, Professions, & Businesses Activities, Resources for Veterans & Military Families, https://dev.michigan.local/som/json?sc_device=json, Playground Inspection Certification Summary CCL-5047 Word, Go to An Online Resource for Skilled Immigrants, Medical Marijuana Program (MMMP) Patients & Caregivers, Learn About CRA Rules, Laws & Regulations, Find / Verify a CRA Licensed Professional or Business, Make a Complaint About a CRA Licensed Professional or Business, Track Marijuana Inventory - Statewide Marijuana Monitoring System (Metrc), Find Panel, Public Hearing & Workgroup Information, Find a Disciplinary Action Report or Document, Learn About CCL Rules, Laws & Regulations, Find / Verify a CCL Licensed Professional or Business, Make a Complaint About a CCL Licensed Professional or Business, Apply for / Renew a BCC License or Permit, Find / Verify a BCC Licensed Professional or Business, Make a Complaint About a BCC Licensed Professional or Business, Learn About Examinations & Continuing Education, Find / Verify a BCHS Licensed Professional or Business, Make a Complaint About a BCHS Licensed Professional or Business, Go to Corporations, Securities & Commercial Licensing, Find / Verify a CSCL Licensed Professional or Business, Make a Complaint About a CSCL Licensed Professional or Business, Contact the Michigan Liquor Control Commission, Local Government & Law Enforcement Resources, Go to Michigan Office of Administrative Hearings and Rules, Administrative Hearings Frequently Asked Questions, Request to Attend a Hearing (for Media Professionals), Go to Michigan Indigent Defense Commission, Learn About Continuing Legal Education (CLE), Make a Complaint or Inquiry About a Utility Provider, Compare Natural Gas Utilities Options (MI Gas Choice), Submit an Underground Utilities Locate Request (MISS DIG 811), Learn About Natural Gas & Pipeline Providers, Learn About Rules of Practice and Procedure, Find / Verify a BPL Licensed Professional or Business, Make a Complaint About a BPL Licensed Professional or Business, Michigan Automated Prescription System (MAPS), Find / Verify a UCC Licensed Professional or Business, Make a Complaint About a UCC Licensed Professional or Business, Go to Apply for / Renew a License or Permit, Go to Find / Verify a Licensed Professional or Business, Go to Make a Complaint About a Licensed Professional or Business, Go to Look Up Underground Storage Tank Information, Go to Look Up a Controlled Substance (MAPS), Go to Access the Online Liquor Ordering (OLO) System, Go to Look Up a Disciplinary Action Report, Go to Submit a Request for Information (FOIA), Go to Regulated Products, Professions, & Businesses Activities, Go to Requesting Information from LARA (FOIA), Go to Resources for Veterans & Military Families, Report of Actual or Suspected Child Abuse or Neglect - DHS-3200 - Spanish, Report of Actual or Suspected Child Abuse or Neglect - DHS-3200 - Arabic, Michigan Child Care and Education Professional Development Record for Child Care Centers CCL-4591 - PDF, Michigan Child Care and Education Professional Development Record for Child Care Centers CCL-4591 - Word, Staffing Plan: Child Care Center CCL-5001 - PDF, Staffing Plan: Child Care Center CCL-5001 - Word, Staffing Plan: Child Care Center CCL-5001 Excel, Child Care License Designee CCL-5003 - PDF, Child Care License Designee CCL-5003 - Word, Certification of School Building Fire Safety Provisions CCL-5043 - PDF, Certification of School Building Fire Safety Provisions CCL-5043 - Word, Self-Certification of Transportation Provisions for Centers CCL-5044 - PDF, Self-Certification of Transportation Provisions for Centers CCL-5044 - Word, Volunteer Certification for Field Trip Transportation CCL-5046 - PDF, Volunteer Certification for Field Trip Transportation CCL-5046 - Word, Playground Inspection Certification Summary CCL-5047 - PDF, Family and Group Child Care Home Compliance Record - BCAL-4601, Preparing for Your License Renewal Fire Safety Inspection - BCAL-5048, Child Care Center Compliance Record, Part 1. Child Abuse/Neglect For every single segment, fill out the content requested by the software. Once completed you can sign your fillable form or send for signing. Listed below are the required forms to be completed by every child care facility owner and employee (age 18 and older) for the required background check per NRS 432A.175. During inspections, licensors will ask to see a government-issued photo ID (or a copy of that ID) for each covered individual. Complete this form within 72 hours of calling in a suspicion of abuse or neglect. YP - The Real Yellow PagesSM - helps you find the right local businesses to meet your specific needs. (The contract is fully executed when both parties have signed and dated the contract.). Department of Social Services San Jose Childcare 2580 North First Street #300 San Jose, CA 95131 (408)324-2148. We received a lot of applications for the 2022 Compliance Grant and hope to have notifications out by the end of September. One copy will be retained by the Operator and the other you may retain . Set a password to access your documents anytime, You seem to be using an unsupported browser. 1774 N University Pkwy. Providers will then have to submit another background check form and fingerprints if they still want the covered individual's background check to be processed. Application Process: Call or visit website for additional information. Love it! Call: (801) 538-4242 ), Veterans Crisis Line: This grant will not be retroactive. ADA Access: Please contact facility for accessibility information. Contact us and well get back to you soon. the application book is "LIC 281" Community Care Updates - Quarterly updates on items of interest and program changes you need to know about. Have questions about licensing and vendorization or about the program designs? Once finished you can manually add any additional fields and signatures to the document by dragging them from the toolbar. Then mail the document to the appropriate Office of Child Care Regional Licensing Office. For questions about this webpage, please call 1-844-538-8766 or email letusno@dss.ca.gov. All forms are printable and downloadable. Update it below and resend. Begin opening a form by clicking on its name or number. ", "UK English Male"); Self-Certification of Transportation Provisions for Centers CCL-5044 - Word, Volunteer Certification for Field Trip Transportation CCL-5046 - PDF Child Care Licensing. Forms. Certification of School Building Fire Safety Provisions CCL-5043 - Word, Self-Certification of Transportation Provisions for Centers CCL-5044 - PDF Send to someone else to fill in and sign. This is to make the processes more efficient. Multi-Agency State Office Building This is accomplished by: Establishing, monitoring, and assessing health and safety standards; Listed below are samples of logs neededin the ongoing operation of a licensed Nevada child care facility. From Business: With our experienced staff and innovative programs unlike any other, our commitment to your child's future. Cancel at any time. We are pleased to announce Child Care Licensing is now part of the newly consolidated Department of Health and Human Services (DHHS). Forms and documents are available in Adobe Acrobat format for free download. (January 30, 2023), Take a minute to watch a tour of the website by clicking here: Childcarelicensing.utah.gov, Tome un minuto para ver una presentacin de nuestro sitio web haciendo clic aqu: Childcarelicensing.utah.gov. or certified family home or resource family and foster family agency, nor any copy of the complaint or any record published, this allows you to receive further information from the local licensing office about the status of this complaint. Multi-Agency State Office Building You can tell they love the kids and care about, 3534 S Highland Dr, Salt Lake City, UT 84106. responsiveVoice.speak("Access the California Department of Social Services - Community Care Licensing Division website at www.ccld.ca.gov The CCL website contains regularly updated information on various topics. About Search Results. Forms on this site are available in several formats. [opens in a new window] Referral Form for Clinical Trials. If you do not have or did not receive a current . Care in the Community. Hours Mon-Fri 8am-5pm; Area(s) Served: Serves: All Areas Fees: Please contact provider for fee information. Below are forms and documents for your inspections. 1-855-323-DCFS(3237) Get started with our no-obligation trial. If you are in crisis or having thoughts of suicide, We license Foster Homes, Child Care Facilities, Human Services Programs, and Health Facilities, utilizing rules established with community support, to protect the dependent and vulnerable citizens of Utah. For questions about this webpage, please call 1-844-538-8766 or email letusno@dss.ca.gov . Administrator Certification Program - Information on approved vendors for all facility administrator programs. They must be completed manually. Default; Distance; Rating; Name (A - Z) Sponsored Links. LIC 624, Unusual Incident/Injury Report (PDF; 78.21 KB) LIC 624 (SP), Reporte de incidente inusual o lesin (pdf; 80.58 KB) Tome un minuto para ver una presentacin de nuestro sitio web haciendo clic aqu: As the result of a federal audit and to ensure the consistency of inspections, licensors are assessing compliance with all rules and requirements at all inspections. They may be usedas posted here or you can create your own versions. Family and Group Home Increased Capacity and Ratio Request - Word Version, Family and Group Home Increased Capacity and Ratio Request PDF Version, Waiver for Decreasing Capacity Fillable Word Version, Waiver for Decreasing Capacity PDF Version, Request of Child Care Forms CCL-2021 PDF, Request of Child Care Forms CCL-2021 Word, Child Care Licensing Information Request - CCL 001 -PDF, Child Care Licensing Information Request - CCL 001 - Word, Medication Permission and Instructions for Child Care Homes/Child Care Centers - CCL-1243 PDF, Medication Permission and Instructions for Child Care Homes/Child Care Centers - CCL-1243 Word, Permiso e Instrucciones Para la Medicacin Para Casas de Cuidado/Guarderias - CCL-1243-SP - PDF, Permiso e Instrucciones Para la Medicacin Para Casas de Cuidado/Guarderias - CCL-1243-SP - Word, Background Check and Fingerprinting Information, Report of Actual or Suspected Child Abuse or Neglect - DHS-3200, Notification of Changes in Status-Family and Group Child Care Home - CCL-1485 - PDF, Notification of Changes in Status-Family and Group Child Care Home - CCL-1485 - Word, Medical Clearance Request - CCL-3704 - PDF, Medical Clearance Request - CCL-3704 - Word, Child Information Record - CCL-3731 - PDF, Child Information Record - CCL-3731 - Word, Child Information Record - CCL 3731-AR (Arabic), Documento de Informacin del Nio Estado de Michigan - CCL-3731-SP, Zoning Approval for Group Child Care Homes - CCL-3748 - PDF, Zoning Approval for Group Child Care Homes - CCL-3748 - Word, Declaracin/Recibo de Nios en Cuidado - CCL-3900-SP, Child in Care Statement/Receipt - CCL-3900 - PDF, Child in Care Statement/Receipt - CCL-3900 - Word, Training Record Family/Group Child Care Homes - CCL-4590 PDF, Training Record Family/Group Child Care Homes - CCL-4590 - Word, Assistant Caregiver Certifications - CCL-4595 - PDF, Assistant Caregiver Certifications - CCL-4595 - Word, Home Fire and Tornado Drill Record - CCL-4593 - PDF, Home Fire and Tornado Drill Record - CCL - 4593 - Word, Licensing Notebook Summary Sheet - CCL-5052 - PDF, Licensing Notebook Summary Sheet - CCL-5052 - Word, Request for Modification of the Terms of the License - CCL-5054 - PDF, Request for Modification of the Terms of the License - CCL-5054 - Word, Variance Request Early Childhood Program Director Fillable Word Version, Variance Request Early Childhood Program Director PDF Version, Variance Request School-Age Program Director Fillable Word Version, Variance Request School-Age Program Director PDF Version, Variance Request Lead Caregiver Fillable Word Version, Variance Request Lead Caregiver PDF Version, Child Care Licensing Information Request - BCHS-CCL 001 - PDF, Child Care Licensing Information Request - BCHS-CCL 001 - Word, Medication Permission and Instructions for Child Care Homes/Child Care Centers - CCL-1243 - PDF, Medication Permission and Instructions for Child Care Homes/Child Care Centers - CCL-1243 - Word, Permiso e Instrucciones Para la Medicacin Para Casas de Cuidado/Guarderias - CCL-1243-SP - Word. The PDF versions are not fillable and are intended for printing. 1-800-371-7897 Community Care Licensing Complaint Form v 1.0, 19-01-CCLD Communication with Complainants FAQs. You will need to contact your local licensing office for all other clearance verifications. See reviews, photos, directions, phone numbers and more for Community Care Licensing locations in Provo, UT. WILLOW GLEN COMMUNITY EXTENDED DAY ENRICHMENT PROGRAM. 195 North 1950 West CCLD's program design consists of the following elements: PART A / licensing Forms. Important News - New licensing fees effective July 28,2009 California Background Clearance Listing - DOJ clearance lists for the past 30 days. The Word documents are fillable and are intended for electronic completion. The CCL website contains regularly updated information on various topics. Community Care, Inc. - Provider Services1801 Dolphin Drive, Waukesha, WI 53186. Before you begin, ensure that you have the latest fee notice from the Department, as new fee notices and PINs are issued annually. LIC 702. This form can be submitted anonymously. Let Us No to submit a complaint. Email: dhslicensing@utah.gov, HotlinesAbuse/Neglect of Seniors and Adults with Disabilities From Business: Orem KinderCare located at 765 E 1200 S in Orem, UT is designed with your child's fun, health, safety, and childhood education in mind. Select option 1 for Claims and Eligibility. What I recommend to all of my clients is this: when we get a facility number assigned to the facility, submit a program design to Regional Center, this way both program designs will be going through the vetting process at the same time, and hopefully cross the finish line around the same time. Upload your own documents or access the thousands in our library. LIC 700. California Community Care Licensing (CCL) Requirements Licensed child care programs must conduct emergency drills at least once every 6 months. Mental Health Forms . File type: PDF. (To attach multiple files, click the first file and then hold the control key down and click on any additional files.). Going back to work after having my baby was really hard for me. Please contact the Community Care Facilities Licensing Program directly for any public details dated after November 4, 2021. Incident Report CCL-4605 - Word, Parent Notification of the Licensing Notebook CCL-5053 PDF, Parent Notification of the Licensing Notebook CCL-5053 - Word, Multiple Occupancy Documentation for Child Care Centers CCL- 2118 PDF, Multiple Occupancy Documentation for Child Care Centers CCL- 2118 Word, Ownership Interest Disclosure CCL-2119 PDF, Ownership Interest Disclosure CCL-2119 Word. } This document has been signed by all parties. LARA is dedicated to bridging the gap between civilian and military employment and helping veterans gain and retain employment. To date, the governor has expanded access to free or low cost child care for 150,000 more kids . Listed below are the required forms to be completed by every child care facility owner and employee (age 18 and older) for the required background check per NRS 432A.175. LIC 624, Unusual Incident/Injury Report. Crisis Line & Mobile Outreach Team Community Care Licensing Division. You can pay fees here with a Visa, MasterCard, or with your debit card, if it has a Visa or MasterCard Logo. Programs are required to keep written For larger documents this process may take up to one minute to complete. Application for Child Care Plan Review (BCHS-FS-13), Child Care Center Notice of Arraignment or Conviction CCL-1486 - PDF, Child Care Center Notice of Arraignment or Conviction CCL-1486 - Word, Child Information Record - CCL-3731 Web Proected, Child Information Record - BCAL 3731-AR (Arabic), Documento de Informacin del Nio Estado de Michigan - BCAL-3731-SP, Written Information Packet Documentation CCL-4340 - PDF, Written Information Packet Documentation CCL-4340 - Word, Change of Use Space Request for School-Age Programs Located in Schools CCL-4342 - PDF, Change of Use Space Request for School-Age Programs Located in Schools CCL-4342 - Word, Lead Hazard Risk Assessment Summary CCL-4344 - PDF, Lead Hazard Risk Assessment Summary CCL-4344 - Word, No Change in Building Construction Declaration CCL-2129 - PDF, No Change in Building Construction Declaration CCL-2129 - Word, Infant/Toddler Primary Caregiver Documentation CCL-4557 - PDF, Infant/Toddler Primary Caregiver Documentation CCL-4557 - Word, Center Fire and Tornado Drill Record - CCL-4593 - PDF, Center Fire and Tornado Drill Record - CCL-4593 - Word, Staffing Plan: Child Care Center CCL-5001 - PDF : call or visit website for additional information call 1-844-538-8766 or email letusno @ dss.ca.gov.... 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