LIC 301B (8/07) - Reference Request - California Department of ... - cdss ca 2026

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The document is a reference request form from the California Department of Social Services for individuals applying to participate in the Long-Term Care Ombudsman Program. It requires the reference provider to provide personal information, their relationship to the applicant, and an assessment of the applicant's character and suitability for the program.

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Click ‘Get Form’ to open it in the editor.
Begin by entering your full name in the designated field at the top of the form. This is essential before passing the form to your reference.
Fill in your street address, city, state, and zip code accurately to ensure proper identification.
Provide your daytime telephone number for any follow-up inquiries regarding your reference.
Answer the questions regarding how long you have known the applicant and your relationship with them. Be honest and detailed in your responses.
Share your opinion on the applicant's character in the provided section, ensuring that you provide thoughtful insights.
Add any additional comments that may support the applicant’s desire to be a Long-Term Care Ombudsman.
Finally, print your name, sign the form, and date it before submission.

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What does the California Department of Social Services do?

The mission of the California Department of Social Services is to serve, protect, and support the people of California experiencing need in ways that empower wellbeing and disrupt systemic inequities.

What is CDSS in California?

The California Department of Social Services is one of 16 departments and offices in the California Health and Human Services Agency. The Department is comprised of more than 5,500 employees who are responsible for the oversight and administration of programs serving Californias most vulnerable residents.

What is CDSS in healthcare?

A Department of Human Services (DHS) or Ministry of Human Services (MHS) is a national or subnational umbrella agency which is responsible for providing public assistance programs to the population they serve. Various aspects or alternate names include social security, social affairs, human resources and welfare.

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What does CDSS stand for in California?

The California Department of Social Services (CDSS) is a state-supervised, county-administered system that provides oversight of programs that affect nearly 3 millions of Californias most vulnerable residentsfoster children and youth, children and families receiving aid through the California Work Opportunities and

LIC 301B (8/07) - Reference Request - California Department of ... - cdss ca 2026

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