Form LIC 9163, Request for Live Scan Service is a legal document which must be completed if you wish to work at, be licensed, or present at a licensed community care facility or organization. "Live Scan Fingerprinting" (or "Live Scan" for short) will electronically transfer your personal details and images of your fingerprints to the Department of Justice (DOJ).
This form was released by the California Department of Social Services (CDSS), a component of the California Health and Human Services Agency (CHHS). The latest version of the form was issued on December 1, 2015, with all previous editions obsolete. You can download a fillable LIC 9163 Form through the link below.
Form LIC 9163 (SP), Petición para Que Se Tomen Las Huellas Digitales Electrónicamente (Live Scan) (a Spanish version of Form LIC 9163) can be downloaded using this link. Form LIC 9163B, Request For Live Scan Service - Long Term Care Ombudsman, is a related document filled out by individuals who will work as a long-term care ombudsman under the state program intended to resolve complaints made by residents in various long-term care facilities.
Pressing the PRINT button will only print the current page. Download the document to your desktop, tablet or smartphone to be able to print it out in full.