Lic 9106-2026

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The document outlines the requirements and procedures for submitting a Group Home Program Statement to the California Department of Social Services' Community Care Licensing Division. It details the licensing process for group homes, including the need for separate licenses for each facility, the establishment of AFDC-FC rates, and the necessary steps for initial applications and revisions. The document also specifies the format for submission, required sections in the program statement, and guidelines for program identification, population served, services provided, staffing, and policies affecting children placed in group homes.

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Click ‘Get Form’ to open the lic 9106 in the editor.
Begin with PART I: PROGRAM IDENTIFICATION. Fill in your applicant/licensee name, program name, and mailing address. Ensure you provide a contact person's name and phone number for any inquiries.
Move to PART II: PROGRAM POPULATION, SERVICES & CAPABILITIES. Check the appropriate boxes to indicate the type of care provided and the target population served. Be specific about services offered and any special programs available.
In PART III: PROGRAM NARRATIVE, describe your program's purpose, methods, and goals. Include details on how children will be assessed and what treatment will be provided.
Compile all sections in order as per the Table of Contents. Use tabbed dividers for easy navigation through your document before submission.

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