Rfa 01b 2026

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The document is a confidential Criminal Record Statement form from the California Department of Social Services, intended for Resource Family applicants and adults living in their homes. It requires disclosure of any criminal convictions or arrests, including those from other states, and emphasizes the importance of full disclosure to avoid application denials. The form also includes a privacy statement regarding the handling of personal information.

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Click ‘Get Form’ to open the rfa 01b in the editor.
Begin with Section I: Out-of-State Disclosure. Indicate if you have lived in another state within the last five years by selecting 'YES' or 'NO'. If 'YES', list each state and ensure to complete a LIC 198B for each.
Move to Section II: Criminal Record Statement. Answer the questions regarding any convictions in California or other jurisdictions. Select 'YES' or 'NO' as applicable.
If you answered 'YES' to any question in Section II, proceed to Section III: Disclosure of Criminal Background. Provide details about each conviction or arrest, including dates and locations.
Complete your personal information at the bottom of the form, including your full name, address, Social Security Number, and signature. Ensure all entries are clear and accurate.

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Versions	Form popularity	Fillable & printable
2019	4.8 Satisfied (114 Votes)

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