Lic 9163 2008 form-2025

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350 votes

The document is a Request for Live Scan Service form from the California Department of Social Services, specifically for Community Care Licensing. It outlines the process for applicants to submit their information for criminal background checks required to work in licensed facilities. The form includes sections for applicant details, facility information, and instructions on completing the Live Scan fingerprinting process.

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Click ‘Get Form’ to open the lic 9163 2008 form in the editor.
Begin by filling in the ORI field, which is preprinted as A0448. This identifies your application.
In the Working Title section, check the appropriate box that describes your role: Adult Resident, Employee, License/Certification Applicant, or Volunteer.
For Authorized Applicant Type, refer to Page 2 of the form and select your facility type from the provided list. Enter its corresponding DOJ abbreviated facility type.
Complete the Agency Address section with the preprinted information for CA Dept of Social Services. Ensure all details are accurate.
Fill out your personal information in the Applicant Information section. Include your full name, date of birth, sex, height, weight, and any other required identifiers.
If applicable, provide your Employer's details in Section 7. This includes their name and address.
Finally, ensure that you take this form to your Live Scan appointment for completion by the operator.

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Versions	Form popularity	Fillable & printable
2015	5 Satisfied (48 Votes)
2011	4.4 Satisfied (44 Votes)
2008	4.4 Satisfied (350 Votes)

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Can you do a live scan online?

California Fingerprinting You can walk in with your Request for Live Scan Service form or enroll online for faster processing. If youre outside of California, we also offer an option to submit fingerprints on an FD-258 fingerprint card to the California DOJ.

What disqualifies you from a Live Scan?

An individual convicted of any crime other than minor traffic violations is disqualified unless the California Department of Social Services (CDSS) grants an exemption from the clearance requirement.

How long does a DOJ Live Scan take?

How long does it take to complete the DOJ/FBI fingerprint process? The Live Scan Process takes approximately 3-7 days once DOJ/FBI receives your 41-LS form. Out-of-state applicants must complete the FD-258 hard-Card manual fingerprint process, which takes approximately 10-12 weeks to complete.

What is lic 9163?

Individuals can obtain a Request for Live Scan form LIC 9163 or from any local Community Care Licensing Division office. This form will automatically request a Child Abuse Central Index (CACI) check if needed.

What is LIC in education?

A longitudinal integrated clerkship (LIC) is an alternative way of structuring the third-year clinical experience. As opposed to rotating through six-week blocks, LIC students are embedded in an outpatient primary care clinic for the entire year, with weekly experiences in pediatrics and womens health.

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How much does a Live Scan cost in CA?

Or you may call the Department of Justices (DOJ) Record Review department at (916) 227-3832. All California background checks are conducted using the Live Scan service. The fee for this service is $55. This fee includes both the California DOJ fees and our $30 rolling fee.