Form LIC 198A at a glance
What it is: LIC 198A is the Child Abuse Central Index Check for State Licensed Facilities of the California Department of Social Services Community Care Licensing Division.
Where and when to file: If the person is submitting fingerprints for a criminal record background check, a request for a check of the CACI will be transmitted to the Department of Justice at the same time.
All persons subject to a background check are also subject to a Child Abuse Central Index (CACI) check, if the facility to which they are associated provides care and supervision to children. This includes all child care centers; family child care homes; children's residential homes and facilities; and adult residential facilities if, through an approved exception or a specialized license, they provide care to a person under age 18.
In order to be licensed, work at, or be present at, a licensed facility, the law requires that you complete a criminal background check (Health and Safety Code sections 1522, 1568.09, 1569.17 and 1596.871).
A filled-in Form LIC 198A example: a child care employee requests a CACI check
How to fill out Form LIC 198A, box by box
Date sent and name
Complete ALL items checked (✔) and type or print the information.
Write the date sent on the DATE SENT line marked ✔.
Enter the name: last, first and middle.
Date of birth, Social Security number and other names
Enter the DATE OF BIRTH as MO., DAY, YEAR.
Enter the SOCIAL SECURITY NUMBER; see the privacy statement on page 2.
The requested SSN is voluntary.
Failure to provide the SSN may delay the processing of this form and the criminal record check.
The California Department of Justice uses a person's SSN as an identifying number.
List all other names you have ever used: on the MAIDEN NAME line and on the NAME/AKA lines.
Current address, MALE or FEMALE, facility telephone number and driver's license number
Enter the CURRENT ADDRESS: STREET, CITY, STATE and ZIP CODE.
Mark MALE or FEMALE.
Enter the FACILITY TELEPHONE NUMBER and the DRIVER'S LICENSE NUMBER.
Facility number, name and address
Enter the FACILITY NUMBER, the FACILITY NAME and the FACILITY ADDRESS: STREET, CITY, STATE and ZIP CODE.
Personnel Type Options
Under PERSONNEL TYPE OPTIONS, mark the box: A FACILITY ADMINISTRATOR/DIRECTOR, C CORPORATION BOARD MEMBER, E EMPLOYEE, F CERTIFIED HOME (FFA), L LICENSEE/APPLICANT, N NONCLIENT ADULT RESIDENT, P PARTNERSHIP MEMBER, S SPOUSE OF LICENSEE (Unless included as a licensee) or U UNKNOWN.
More rules for Form LIC 198A
Under the California Public Records Act, the Department may have to provide copies of some of the records in the file to members of the public who ask for them, including newspaper and television reporters.
The Department is required to tell people who ask, including the press, if some one in a licensed facility has a crminal record exemption.
The Department must also tell people who ask, the name of a licensed facility that has a licensee, employee, resident, or other person with a criminal record exemption.
Common questions about Form LIC 198A
Where do I file it?
If a CACI check is required subsequent to a California Department of Social Services (CDSS) processed criminal record background check, it is the licensee's responsibility to submit this form and appropriate fees directly to the Department of Justice, P. O. Box 903417, Sacramento, CA 94203-4170.
Are there fees?
Include $15.00 for each Child Abuse Central Index Check (checked November 2, 2026). There is no exemption from this fee. Make check or money order payable to the Department of Justice.
Where to get help with Form LIC 198A
If you have any questions about this form, please contact your local licensing regional office.
Sources
[1] Form LIC 198A (3/11), Child Abuse Central Index Check for State Licensed Facilities, California Department of Social Services (the Official source link on this page).