Section 86501.5 - Definitions - Forms(a) The following forms, which are incorporated by reference, apply to the regulations in Title 22, Division 6, Chapter 7.3 (Crisis Nurseries). (1) LIC 165 (8/07) -- Board of Directors Statement(2) LIC 198 (2/01) -- Child Abuse Central Index Check for County Licensed Facilities.(3) LIC 198A (8/07) -- Child Abuse Central Index Check for State Licensed Facilities.(4) LIC 200 (8/04) -- Application for a Community Care Facility or Residential Care Facility for the Elderly License.(5) LIC 300A (9/03) -- Removal Confirmation -- Exemption Needed(6) LIC 300B (9/03) -- Removal Confirmation -- Denial(7) LIC 300C (9/03) -- Removal Confirmation -- Rescinded(8) LIC 300D (9/03) -- Removal Confirmation -- Non-Exemptible(9) LIC 301E (7/03) -- Reference Request(10) LIC 309 (6/01) -- Public Administrative Organization.(11) LIC 400 (1/99) Public -- Affidavit Regarding Client/Resident Cash Resources.(12) LIC 401 (3/01) -- Monthly Operating Statement.(13) LIC 403 (11/02) -- Balance Sheet.(14) LIC 403A (12/02) -- Balance Sheet Supplemental Schedule.(15) LIC 404 (7/99) (Personal) -- Financial Information Release and Verification.(16) LIC 508 (1/03) -- Criminal Record Statement.(17) LIC 9182 (12/06) -- Criminal Background Clearance Transfer Request.(18) LIC 9188 (12/06) -- Criminal Record Exemption Transfer Request.(19) LIC 9219 (3/16) -- Crisis Nursery Monthly Report.(20) LIC 9219A (3/16) -- Crisis Day Services Sign-In/Sign-Out Sheet.Cal. Code Regs. Tit. 22, § 86501.5
1. New section filed 12-31-2007; operative 12-31-2007 (Register 2008, No. 1).
2. Change without regulatory effect amending subsections (a)(19) and (a)(20) and amending NOTE filed 8-17-2016 pursuant to section 100, title 1, California Code of Regulations (Register 2016, No. 34). Note: Authority cited: Section 1530, Health and Safety Code. Reference: Sections 1516, 1520, 1522 and 1522.1, Health and Safety Code.
1. New section filed 12-31-2007; operative 12-31-2007 (Register 2008, No. 1).