Please complete one form for each facility number.
Approval: the transfer must be approved by the Department before the individual who is the subject of the transfer has initial presence in the facility/organization.
CACI: a Child Abuse Central Index (CACI) clearance must be on file if the transfer is to a facility serving children.
Identity: the licensee must verify the identity of the applicant who is seeking the exemption transfer, if applicable.
SSN: the requested SSN is voluntary; failure to provide the SSN may delay the processing of this form and the criminal record check.
| Question | Answer |
|---|---|
| Form Name | LIC 9188 |
| Form Length | 5 pages |
| Fillable? | Yes |
| Fillable fields | 52 |
| Avg. time to fill out | 9 min |
| Edition | Rev 1/26 |
| Issuing agency | California Department of Social Services |
| Where to send | CPMBTransfers@dss.ca.gov, fax to (916) 754-4589, or mail to Department of Social Services 744 P Street, MS T9-15-62 Sacramento, CA 95814 |
| Matches the agency's file | Yes, checked October 2, 2026 |
| Other names | LIC 9188, LIC9188, 9188, Criminal Record Exemption Transfer Request |
| Official source | LIC 9188 (Rev 1/26), California Department of Social Services |
Form Lic 9188 isn’t the one you’re looking for?