Form LIC 9163, Request for Live Scan Service, commonly referred to as the Live Scan Form, 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.
If you prefer to complete a Spanish version of the document, download Form LIC 9163 (SP), Petición para Que Se Tomen Las Huellas Digitales Electrónicamente (Live Scan), on our website 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.