Form LIC 9182 Criminal Background Clearance Transfer Request - California

What Is LIC 9182 Form?

Form LIC 9182, Criminal Background Clearance Transfer Request is a document used to apply for a transfer of an active criminal record from one state licensed facility to another. This is a state-specific form designed and issued by the California Department of Social Services Community Care Licensing Division. The most recent version of the form was released in November 2015. Download the up-to-date LIC 9182 fillable form through the link below.

California state law demands fingerprints of all the community care license applicants. This requirement includes adults who are employees at licensed community care facilities or home care organizations, and home care aide applicants, both independent and affiliated to a home care organization. The initial community care licensing fingerprint clearance or the Community Care Licensing Division (CCLD) fingerprint clearance is provided by the Caregiver Background Check Bureau.

After the clearance was granted, it can be transferred from one facility to another. For this purpose, a license applicant or a licensee must submit an LIC 9182 Form. To avoid delays during the transfer processing, you are not required to be re-fingerprinted if you already have an active clearance. To verify your status, contact your local CCLD office.

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Download Form LIC 9182 Criminal Background Clearance Transfer Request - California

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Form LIC 9182 Instructions

The instructions for the Criminal Background Clearance Transfer Request include the following:

  1. Use this form to request only a transfer of an active criminal record clearance. If you need to transfer an active exemption, submit Form LIC 9188, Criminal Record Exemption Transfer;
  2. Fill out Form LIC 9182 to transfer clearance between state-licensed facilities only. To request a transfer from the TrustLine Registry, use the Form TLR 3, Trustline to Community Care Licensing Criminal Background Clearance Transfer Request;
  3. You may request a transfer of criminal background clearance to more than one facility on one form. For this purpose, attach a list containing the facility number for each facility to which the clearance should be transferred;
  4. The form must be submitted before the individual subject to transfer has asses to the facility clients;
  5. If the individual starts working at the facility before the criminal background clearance transfer request is submitted, the community care facility or organization will be subject to a civil penalty. The amount of the penalty is $100;
  6. The licensee or the license applicant must attach Form LIC 508 and a copy of the permanent resident card, the individual's driver license, or any valid photo identification to Form LIC 9182. Moreover, if the individual is transferred to a facility serving children, a Child Abuse Central Index Check must be submitted;
  7. The Social Security number (SSN) box on this form is optional. However, it is often used as an identifying number and failure to provide the SSN may delay the processing of this transfer request;
  8. The individual seeking for transfer does not need to wait for a confirmation of the clearance transfer. As soon as the transfer request form is submitted, the individual can start working in the facility.

Where to Send LIC 9182?

Submit the form to a local CCLD office. Find the list of all local offices and their contact information on the California Department of Social Services (CDSS) website. Individuals who wish to receive a community care license, provide services, work or reside in a licensed community care facility will need to fill out two more forms:

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