Form LIC229 "Certificate of Approval" - California

What Is Form LIC229?

This is a legal form that was released by the California Department of Social Services - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on September 1, 1999;
  • The latest edition provided by the California Department of Social Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;

Download a fillable version of Form LIC229 by clicking the link below or browse more documents and templates provided by the California Department of Social Services.

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Download Form LIC229 "Certificate of Approval" - California

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING
CERTIFICATE OF APPROVAL
(for certified family homes)
Note: The Community Care Facilities Act beginning with Section 1500 of the California Health and Safety Code
authorizes the State Department of Social Services to license agencies to engage in homefinding functions. The Foster
Family Agency listed below is authorized by the Community Care Licensing Division of the State Department of Social
Services to recruit, train, select and certify for exclusive use certain homes that meet state licensing standards and are
suitable for the Foster Family Agency’s placement need. A residential home selected and approved for exclusive use for
the reception and care of children placed by the Foster Family Agency is exempt from the requirement of licensure, but
must otherwise meet licensing standards. This form is used as an authorization by the Foster Family Agency to verify
that a selected home is certified for exclusive placement. The original is to be posed or maintained in the home. A copy
shall be maintained in file at the agency.
In accordance with applicable provisions of the Health and Safety Code of California and regulations of the California
State Department of Social Services, the licensed Foster Family Agency shown below hereby grants certification to:
Home Provider____________________________________________________________________________________
Home Address____________________________________________________________________________________
________________________________________________________________________________________________
to receive and provide care for children placed by the agency.
This Certificate of Approval:
1. Does not permit the acceptance of children for care from any other agency, individual, parent or guardian.
2. Is not transferable; is limited to the terms of the certificate, and is valid for one year but may be terminated earlier
at the discretion of the Foster Family Agency.
3. Is granted upon the following conditions:
Capacity_____________________________________ Age Range of Children ____________________________
Ambulatory Status of Home ______________________________________________________________________
Client Preferences______________________________________________________________________________
Specific Limitations ____________________________________________________________________________
Effective Date________________________________
Expiration Date __________________________________
I hereby certify that the above named facility meets the licensing standards in California Administrative Code, Title 22,
Division 6.
Foster Family Agency
License Number
Address
Foster Family Agency Representative
City,
State,
Zip Code
Title
LIC 229 (9/99) PUBLIC
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING
CERTIFICATE OF APPROVAL
(for certified family homes)
Note: The Community Care Facilities Act beginning with Section 1500 of the California Health and Safety Code
authorizes the State Department of Social Services to license agencies to engage in homefinding functions. The Foster
Family Agency listed below is authorized by the Community Care Licensing Division of the State Department of Social
Services to recruit, train, select and certify for exclusive use certain homes that meet state licensing standards and are
suitable for the Foster Family Agency’s placement need. A residential home selected and approved for exclusive use for
the reception and care of children placed by the Foster Family Agency is exempt from the requirement of licensure, but
must otherwise meet licensing standards. This form is used as an authorization by the Foster Family Agency to verify
that a selected home is certified for exclusive placement. The original is to be posed or maintained in the home. A copy
shall be maintained in file at the agency.
In accordance with applicable provisions of the Health and Safety Code of California and regulations of the California
State Department of Social Services, the licensed Foster Family Agency shown below hereby grants certification to:
Home Provider____________________________________________________________________________________
Home Address____________________________________________________________________________________
________________________________________________________________________________________________
to receive and provide care for children placed by the agency.
This Certificate of Approval:
1. Does not permit the acceptance of children for care from any other agency, individual, parent or guardian.
2. Is not transferable; is limited to the terms of the certificate, and is valid for one year but may be terminated earlier
at the discretion of the Foster Family Agency.
3. Is granted upon the following conditions:
Capacity_____________________________________ Age Range of Children ____________________________
Ambulatory Status of Home ______________________________________________________________________
Client Preferences______________________________________________________________________________
Specific Limitations ____________________________________________________________________________
Effective Date________________________________
Expiration Date __________________________________
I hereby certify that the above named facility meets the licensing standards in California Administrative Code, Title 22,
Division 6.
Foster Family Agency
License Number
Address
Foster Family Agency Representative
City,
State,
Zip Code
Title
LIC 229 (9/99) PUBLIC