Form LIC9165 Board of Director Governing Body Statement - California

What Is Form LIC9165?

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.

FAQ

Q: What is the LIC9165 form?
A: The LIC9165 form is the Board of Director Governing Body Statement in California.

Q: Who needs to fill out the LIC9165 form?
A: The LIC9165 form needs to be filled out by the board of directors or governing body of a licensed facility in California.

Q: What is the purpose of the LIC9165 form?
A: The purpose of the LIC9165 form is to provide information about the board of directors or governing body of a licensed facility in California.

Q: Are there any fees associated with the LIC9165 form?
A: No, there are no fees associated with the LIC9165 form.

Q: What information is required on the LIC9165 form?
A: The LIC9165 form requires information such as the names and addresses of the board members, their roles and responsibilities, and any financial interest they may have in the facility.

Q: When do I need to submit the LIC9165 form?
A: The LIC9165 form needs to be submitted with the initial license application and renewed every two years thereafter.

Q: What happens if I don't submit the LIC9165 form?
A: Failure to submit the LIC9165 form may result in delays or denial of your license application or renewal.

Q: Can I make changes to the LIC9165 form after submission?
A: Yes, you can make changes to the LIC9165 form by submitting an amended form to the licensing office.

Q: Can I request a copy of the LIC9165 form for my records?
A: Yes, you can request a copy of the LIC9165 form for your records from the licensing office.