This form may only be used to request a clearance transfer between eligible state licensed facilities/organizations/homes.
Who requests: active criminal record clearances may be transferred by a license applicant or licensee.
Identity: the licensee must verify the identity of the applicant who is seeking the clearance transfer, if applicable.
CACI: a Child Abuse Central Index (CACI) clearance must be on file if the transfer is to a facility serving children.
One form each: please complete one form for each facility number.
Where to send: submit completed forms to your licensing office.
| Question | Answer |
|---|---|
| Form Name | Form LIC 9182 |
| Form Length | 5 pages |
| Fillable? | Yes |
| Fillable fields | 56 |
| Avg. time to fill out | 10 min |
| Edition | 12/25 |
| Issuing agency | California Department of Social Services |
| Where to send | Your licensing office |
| Matches the agency's file | Yes, checked October 2, 2026 |
| Other names | LIC 9182, LIC9182, Criminal Background Clearance Transfer Request, clearance transfer request, CDSS LIC 9182 |
| Official source | Form LIC 9182 (Rev 12/25), California Department of Social Services |
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