Form Lic 9188 PDF Details

The Lic 9188 form, issued by the State of California Health and Human Services Agency and the California Department of Social Services Community Care Licensing Division, serves a critical function in the transfer of active criminal record exemptions between state-licensed facilities. This process enables a licensee or license applicant to request the transfer of an individual’s criminal record exemption to another facility, ensuring that regulatory compliance is maintained to prevent violations and potential civil penalties. It's essential that the department's approval is obtained before the individual starts having contact with clients in the new facility. The requestor must verify the identity of the individual using valid photo identification and, if transferring to a facility that serves children and a Child Abuse Central Index (CACI) check has not previously been done or is outdated, submit a new CACI check directly to the Department of Justice. Notably, this form emphasizes the importance of maintaining legal and regulatory standards within California’s network of care facilities, focusing on safeguarding the well-being of clients and upholding the integrity of care providers. Furthermore, the inclusion of a privacy statement in the form highlights the balance between transparency, privacy, and security, underlining the measures taken to protect individuals' information while complying with state laws and societal expectations.

QuestionAnswer
Form NameForm Lic 9188
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other nameslic 9188 form, criminal record exemption letter, ca lic 9188, criminal record exemption transfer request form

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1. First of all, while filling in the criminal record exemption, start in the page that has the subsequent blank fields:

fingerprint transfer request form completion process shown (step 1)

2. The third step is to fill in these particular blank fields: STREET ADDRESS, CITY, STATE, ZIP CODE, Facility Administrator, I certify I have verified the, Title licensee administrator, Signature, DATE OF EXEMPTION TRANSFER ENTRY, INITIAL OF PERSON ENTERING TRANSFER, FOR DISTRICT OFFICE USE ONLY, LIC, and FILE IN NEWLY ASSOCIATED FACILITY.

Filling out part 2 of fingerprint transfer request form

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