Lic 400 2026

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4.9 out of 5

46 votes

The document is an affidavit from the California Department of Social Services, Community Care Licensing Division, regarding the bonding requirements for facilities handling client or resident cash resources. It outlines the statutory obligations under California Health and Safety Code, specifying that licensed facilities must be bonded for at least $1,000 unless they meet certain criteria. The form is required for new applications, license renewals, or when reassessing bonding needs. It also details the certification process for applicants/licensees and emphasizes the importance of maintaining accurate records and safeguards for cash resources.

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Click ‘Get Form’ to open the LIC 400 in the editor.
Begin by entering your name(s) in the designated field at the top of the form. This identifies you as the applicant or licensee.
Next, provide the name of your facility in the corresponding section. Ensure this matches your official licensing documents.
Fill in the address details, including street, city, and county where your facility is located.
Indicate whether you operate a Community Care Facility (CCF), Residential Care Facility for the Elderly (RCFE), or Residential Care Facility for the Chronically Ill (RCF-CI) by checking the appropriate box.
Select one option regarding cash resources: either specify the maximum amount you will handle monthly or indicate that you will not handle any cash resources.
If a bond is required, enter the amount in the provided space and ensure it meets state requirements based on your facility's operations.
Finally, sign and date the form at the bottom to certify that all information is accurate and complete.

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1999	4.9 Satisfied (46 Votes)

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Lic 400 2026

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Lic 400 2026

Here's how it works

How to use or fill out lic 400 with our platform

See more lic 400 versions

Complete this form in 5 minutes or less

Got questions?

Can I draw my electronic signature to sign my lic 400 form?

What browser do I need to edit regarding client resident cash resources online?

affidavit regarding client resident cash resources

Security and compliance

california lic affidavit resident form

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