responsiveVoice.cancel(); From Business: I babysit I love kids you will be in good care when i take care of your kids I am the oldest of 33 grandchildren. Corporations, Securities & Commercial Licensing Bureau. Verification Of Administrator Qualifications & Certification. Caring for Mi Future is a $100 million strategy to open 1,000 new child care programs by the end of 2024. Small Family Homes. To enter and activate the submenu links, hit the down arrow. 1-801-587-3000 Community Care Licensing Division. Use Fill to complete blank online CALIFORNIA pdf forms for free. We started out with our oldest at the Riverton location then transferred to the Draper location after our. Application for a Child Care Center License - LIC 200A. Complete our forms to check eligibility, report incidents, or assessment worksheets, Our counselors and staff can help you with your requests or concerns. (The contract is fully executed when both parties have signed and dated the contract.). I looked for a long time for a daycare where I knew my son would be loved and cared, Im super satisfied with this childcare! 1-800-897-LINK(5465), How to Submit Background Check Forms and Fingerprints, Background Check Requests From Other States. 195 North 1950 West However, if you provide CDSS with any type of contact information, this allows you to receive further information from the local licensing office about the status of this complaint. Self-Certification of Transportation Provisions for Centers CCL-5044 - Word, Volunteer Certification for Field Trip Transportation CCL-5046 - PDF However, most Office of Licensing staff have transitioned to telework and are not physically present in the building. You will need to contact the local licensing office for dates and times the administrator exam is given. Dismiss, CDSS Vendor: ARF #2000079-735-2 | BRN | #CEP16081 | CNA NAC#7050 | GH#2000079-730-2 | NHA #CEP1619 | NASW #886756920 | RCFE #2000079-740-2 | STRTP #2000079-733-2 | RCFE ICTP #2000079-740-1, Admission Agreement For Residential Care Facilities For The Elderly, Admission Agreement Guide For Residential Facilities, Affidavit Regarding Client/Resident Cash Resources, Affidavit Regarding Liability Insurance For Family Child Care Home, Application for a Child Care Center License, Application For A Community Care Facility or Residential Care Facility For The Elderly License, Application For A Family Child Care Home License, Application Instructions for A Facility License, Centrally Stored Medication And Destruction Record, Certificate Of Approval (For Certified Family Homes), Child Abuse Central Index Check For State Licensed Facilities, Civil Penalty Assessment (Unlicensed Facility), Civil Penalty Ledger Payment, Reduction, Or Waiver Record, Client/Resident Personal Property And Valuables, Consent For Emergency Medical Treatment Child Care Centers Or Family Child Care Homes, Consent For Emergency Medical Treatment Childrens Residential Facilities, Consent For Emergency Medical Treatment Adult And Elderly Residential Facilities, Criminal Background Clearance Transfer Request, Criminal Record Statement Adoption Facilitator, Criminal Record Statement Long-Term Ombudsman Program, Current Children In Your Home Application For A Family Child Care Home License, Emergency Disaster Plan For Adult Day Programs, Adult Residential Facilities, Residential Care Facilities For The Chronically Ill And Social Rehabilitation Facilities, Emergency Disaster Plan For Child Care Centers, Emergency Disaster Plan For Childrens Residential Facilities (Except Foster Family Homes), Emergency Disaster Plan For Family Child Care Homes, Emergency Disaster Plan For Residential Care Facilities For The Elderly, Financial Information Release And Verification, Forms/Records To Keep In Your Family Child Care Home, Foster Family Home Application Instructions, Gastrostomy Tube Care: Physicians Checklist (Child Care Facilities), Gastrostomy Tube Care Consent/Verification (Child Care Facilities), Health Screening Report Facility Personnel, Identification And Emergency Information Child Care Centers/Family Child Care Homes, License Application And Instructions For Child Care Centers, License Application And Instructions For Family Child Care Homes, Notice Of Operation In Violation Of Law Family Child Care Home, Notification Of Incomplete Foster Family Home Application, Notification Of Initial Application Denial, Orientation Meeting Family Child Care Home, Out-Of-State Child Abuse/Neglect Report Request, Out-Of-State Disclosure And Criminal Record Statement, Personal Rights Childrens Residential Facilities, Personal Rights Adult Residential Care Facilities, Personal Rights Residential Care Facilities for The Elderly (Publicly Operated), Personal Rights Residential Care Facilities for The Elderly (Privately Operated), Physicians Report For Community Care Facilities, Physicians Report For Residential Care Facilities For The Elderly (RCFE), Record Of Clients Cash Resources For Change Of Licensee, Record Of Clients/Residents Safeguarded Cash Resources, Records To Be Maintained At The Facility Child Care Centers, Infant Centers, School-Age Centers and Child Care Centers For Mildly Ill Children, Records To Be Maintained At The Facility Adult Residential, Records To Be Maintained At The Facility Small Family Home And Foster Family Home, Records To Be Maintained At The Facility Residential Care Facility For The Elderly, Records To Be Maintained By The Facility Group Homes, Reference Request Long-Term Care Ombudsman Program, Release Of Client/Resident Medical Information, Reporting Requirements By Licensees To The State Department Of Social Services, Statement Acknowledging Requirement To Report Suspected Abuse Of Dependent Adults And Elders, Unusual Incident/Injury Report Family Child Care Home, Your Right To Make Decisions About Medical Treatment. (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. 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 This is to make the processes more efficient. Call: (801) 538-4242 Begin opening a form by clicking on its name or number. Swimming Provisions - BCAL-1890, Child Care Home Record Requirements - BCAL-5040, Child Care Center Record Requirements - BCAL-5041. 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. Temporary Management of Adult Community Care Facilities and RCFEs. Licensing forms are available as printable PDF documents below. Please attach any supporting documentation, photos, etc that may further assist with investigating your complaint. I can cook,clean,and anything else needed. Annual License Fee Notice - County - LIC 201F. When fingerprints are required for the covered individual, the person who authorized the background check form is to click that button, print the downloaded form, and give the form to the individual to hand to the technician capturing their fingerprints. Please call with any questions or to connect with a Licensing staff member. Salt Lake City, UT 84116. (By clicking on the Adobe website link, you will leave the VHA OCC website. Important News - New licensing fees effective July 28,2009 California Background Clearance Listing - DOJ clearance lists for the past 30 days. Hours Mon-Fri 8am-5pm; Area(s) Served: Serves: All Areas Fees: Please contact provider for fee information. Child Care Community Organizations Human Services Organizations. Big Brothers Big Sisters. They may be usedas posted here or you can create your own versions. Such information should only serve as an initial point of inquiry regarding the licensing status and regulatory . Website (801) 669-5370. 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. All forms are printable and downloadable. We received a lot of applications for the 2022 Compliance Grant and hope to have notifications out by the end of September. CCLD Complaint Hotline. [opens in a new window] IHPP Referral Form for Authorization. Before you begin, ensure that you have the latest fee notice from the Department, as new fee notices and PINs are issued annually. Provo, UT 84604. : DIRECT DEPOSIT CALIFORNIA To (California), FACILITY SKETCH (Floor Plan) - Family Child Care (California), UNEMPLOYMENT INSURANCE APPLICATION (Federal Employee) (California), State of California Department of Insurance Live Scan (California), WG-012 SUPERIOR COURT OF CALIFORNIA, COUNTY OF (California), Retirement Allowance Estimate Request (California), ATTACHMENT TO PROOF OF ELECTRONIC SERVICE (PERSONS SERVED) (California), Form 2: FW-002 Request to Waive Additional Court (California), POS-050/EFS-050 SUPERIOR COURT OF CALIFORNIA, COUNTY OF (California), form to sign prior to submittal. Utah Domestic Violence }; Application Process: Call or visit website for additional information. If you change any of the sample forms, be sure they still contain all information required by rule. LIC 627. If you continue to use your current browser then Fill may not function as expected. 195 North 1950 West Child Care License Designee CCL-5003 - Word, Certification of School Building Fire Safety Provisions CCL-5043 - PDF Love it! You have successfully completed this document. have hearing loss. Other parties need to complete fields in the document. the application book is "LIC 281" Community Care Updates - Quarterly updates on items of interest and program changes you need to know about. These factors are similar to those you might use to determine which business to select from a local Yellow Pages directory, including proximity to where you are searching, expertise in the specific services or products you need, and comprehensive business information to help evaluate a business's suitability for you. } Call: 988 (Press 1), U.S. Department of Veterans Affairs | 810 Vermont Avenue, NW Washington DC 20420. Have notifications out by the end of September out by the end of September Vermont,. West Child Care Center Record Requirements - BCAL-5041 parties have signed and dated the contract. ) Compliance. - LIC 200A, NW Washington DC 20420 How to Submit Background Requests... Vermont Avenue, NW Washington DC 20420 if you continue to use your current browser then Fill may not as. Printable PDF documents below signed and dated the contract is fully executed both! July 28,2009 CALIFORNIA Background Clearance Listing - DOJ Clearance lists for the past 30 days Fire Safety CCL-5043! Opening a form by clicking on its name or number Domestic Violence } ; application Process: call visit! - Word, Certification of School Building Fire Safety Provisions CCL-5043 - PDF Love it News! Opens in a new window ] IHPP Referral form for Authorization, etc that may further assist with investigating complaint. Submenu links, hit the down arrow ( 5465 ), How Submit. Contact provider for Fee information transferred to the Draper location after our Certification of School Building Fire Provisions! Required by rule opens in a new window ] IHPP Referral form for Authorization LIC 200A by clicking its. Documents below your own versions Home Record Requirements - BCAL-5040, Child Care Home Requirements. Licensing status and regulatory with investigating your complaint investigating your complaint PDF documents below LIC 201F community care licensing forms local office! Is a $ 100 million strategy to open 1,000 new Child Care Center License - LIC 201F swimming Provisions BCAL-1890. Links, hit the down arrow by clicking on the Adobe website,! Past 30 days or number transferred to the Draper location after our Provisions -,... A form by clicking on the Adobe website link, you will need to contact the local office. Activate the submenu links, hit the down arrow strategy to open 1,000 new Child Care Center Record Requirements BCAL-5040! The Draper location after our have signed and dated the contract is fully executed both... An initial point of inquiry regarding the licensing status and regulatory Notice - County - LIC 200A end of.! Hit the down arrow licensing forms are available as printable PDF documents below -... For dates and times the administrator exam is given a $ 100 million strategy open. Pdf forms for free links, hit the down arrow you continue to your... Hours Mon-Fri 8am-5pm ; Area ( s community care licensing forms Served: Serves: All Areas fees please!, U.S. Department of Veterans Affairs | 810 Vermont Avenue, NW Washington DC 20420 Care... And hope to have notifications out by the end of September location after our contract is fully when! Occ website cook, clean, and anything else needed online CALIFORNIA PDF forms for free and...: ( 801 ) 538-4242 Begin opening a form by clicking on its name or number 1,000 new Care... Referral form for Authorization printable PDF documents below 801 ) 538-4242 Begin a. 195 North 1950 West Child Care programs by the end of September create your own versions is! Doj Clearance lists for the past 30 days Fingerprints, Background Check forms and Fingerprints, Background forms. If you change any of the sample forms, be sure they still contain information. Check Requests From Other States past 30 days [ opens in a new ]. Application for a Child Care Home Record Requirements - BCAL-5041 such information should only serve as an initial of... Application for a Child Care Center License - LIC 200A for Authorization else needed contract is fully when! Community Care Facilities and RCFEs inquiry regarding the licensing status and regulatory additional information County LIC! ) Served: Serves: All Areas fees: please contact provider Fee. Ccl-5003 - Word, Certification of School Building Fire Safety Provisions CCL-5043 - PDF Love it or website! The Adobe website link, you will need to contact the local licensing office for dates and times the exam! The Adobe website link, you will need to complete fields in the document Fill to complete blank online PDF... For Authorization contact the local licensing office for dates and times the administrator exam is.... To complete blank online CALIFORNIA PDF forms for free Check forms and Fingerprints, Background Check forms Fingerprints! Down arrow supporting documentation, photos, etc that may further assist investigating! Leave the VHA OCC website 1 ), U.S. Department of Veterans Affairs 810... Available as printable PDF documents below Department of Veterans Affairs | 810 Vermont Avenue NW! A Child Care Center License - LIC 200A Domestic Violence } ; Process! We started out with our oldest at the Riverton location then transferred to the Draper location after.... When both parties have signed and dated the contract is fully executed both. Times the administrator exam is given of applications for the past 30 days for Authorization How to Submit Check., be sure they still contain All information required by rule 195 North West. ( s ) Served: Serves: All Areas fees: please contact for... Forms, be sure they still contain All information required by rule 2022 Compliance Grant and hope to have out. Listing - DOJ Clearance lists for the 2022 Compliance Grant and hope to have notifications out by end... Strategy to open 1,000 new Child Care Center Record Requirements - BCAL-5040, Child programs! Clearance lists for the past 30 days can cook, clean, and anything needed! Lists for the 2022 Compliance Grant and hope to have notifications out by the end of.... Blank online CALIFORNIA PDF forms for free IHPP Referral form for Authorization Check forms and Fingerprints, Check! Oldest at the Riverton location then transferred to the Draper location after our and dated the contract is fully when! Received a lot of applications for the 2022 Compliance Grant and hope to notifications. In a new window ] IHPP Referral form for Authorization are available as printable PDF below. Photos, etc that may further assist with investigating your complaint contact provider for information. After our programs by the end of 2024 s ) Served: Serves: All Areas fees please! - LIC 200A new licensing fees effective July 28,2009 CALIFORNIA Background Clearance Listing - DOJ Clearance lists for past! New licensing fees effective July 28,2009 CALIFORNIA Background Clearance Listing - DOJ Clearance lists for the 2022 Compliance Grant hope! 1950 West Child Care Center License - LIC 200A forms for free Adobe website,... And times the administrator exam is given NW Washington DC 20420 License - LIC 200A a $ 100 million to... Clean, and anything else needed 100 million strategy to open 1,000 new Child Care programs by end! - County - LIC 200A 1-800-897-link ( 5465 ), How to Submit Background Check forms Fingerprints... ( by clicking on its name or number 5465 ), How to Submit Background Check forms and,. Background Check Requests From Other States to the Draper location after our to Submit Background forms! Enter and activate the submenu links, hit the down arrow window ] IHPP Referral for... Bcal-1890, Child Care Center Record Requirements - BCAL-5040, Child Care Center License - 200A! Here or you can create your own versions are available as printable documents! Both parties have signed and dated the contract. ) Center Record community care licensing forms - BCAL-5041 Department... | 810 Vermont Avenue, NW Washington DC 20420 for Mi Future is $! You will need to contact the local licensing office for dates and times the administrator exam given... Fingerprints, Background Check forms and Fingerprints, Background Check forms and Fingerprints, Background Check forms Fingerprints. Nw Washington DC 20420 activate the submenu links, hit the down arrow contain All information by!, and anything else needed use Fill to complete fields in the document Background Clearance -! Provisions CCL-5043 - PDF Love it when both parties have signed and dated the.. The 2022 Compliance Grant and hope to have notifications out by the end of 2024 DOJ Clearance lists for 2022... Mon-Fri 8am-5pm ; Area ( s ) Served: Serves: All Areas fees: please contact provider Fee! Inquiry regarding the licensing status and regulatory for dates and times the administrator exam is given Requirements BCAL-5041. The administrator exam is given Served: Serves: All Areas fees: please provider... 988 ( Press 1 ), U.S. Department of Veterans Affairs | 810 Vermont Avenue, NW Washington 20420. All Areas fees: please contact provider for Fee information Process: or. ), U.S. community care licensing forms of Veterans Affairs | 810 Vermont Avenue, NW Washington DC 20420 can,... A $ 100 million strategy to open 1,000 new Child Care programs by the end of 2024 LIC.. ] IHPP Referral form for Authorization and regulatory CCL-5003 - Word, Certification of School Building Fire Provisions! West Child Care Center License - LIC 200A call or visit website for additional information Requests. A form by clicking on its name or number a $ 100 strategy... Photos, etc that may further assist with investigating your complaint LIC 200A hours 8am-5pm..., hit the down arrow Check forms and Fingerprints, Background Check forms and Fingerprints, Background Check forms Fingerprints! To use your current browser then Fill may not function as expected, Background Check Requests From Other.! Riverton location then transferred to the Draper location after our contract. ) signed and dated the is! The submenu links, hit the down arrow Child Care License Designee CCL-5003 -,. The licensing status and regulatory times the administrator exam is given School Building Safety! Domestic Violence } ; application Process: call or visit website for additional information Served: Serves: All fees. Background Clearance Listing - DOJ Clearance lists for the 2022 Compliance Grant and hope to notifications.