Free Lic 279 Form in PDF

Instructions on Writing Lic 279

Filling out the LIC 279 form is a critical step toward establishing a family child care home in California. This document is essential for both the California Department of Social Services and the applicant, as it gathers necessary information to ensure the proposed child care environment meets the required health and safety standards. After this form and any additional required documentation are submitted, the next steps involve a thorough review by the Community Care Licensing Division, potential inspections of the home to assess compliance with licensing requirements, and ultimately, the issuance of a license if all criteria are met. Properly completing this form is the foundation of a successful application process.

1. Under TYPE OF APPLICATION, check the box that best describes your application: New Application, Capacity Change, Location Change, or Update.
2. In the APPLICANT(S) section, enter the first, middle, and last names of each applicant and indicate whether each is over 18 years old by checking the appropriate box.
3. For 3a. YOUR HOME ADDRESS, provide the complete address of the home where child care will be provided, including city, county, state, zip code, and primary phone number.
4. If applicable, under 3b. LIST OF ADDITIONAL COUNTIES, list all counties you have resided in during the past two years if you haven't lived in your current county for that period.
5. For 4. MAILING ADDRESS, enter your mailing address if it is different from your home address. If the same, simply write "Same". The email address is optional.
6. In the 5. DIRECTION(S) TO HOME field, provide clear directions to your home. Attach a sketch or map if necessary.
7. Under 6. LICENSE OR CERTIFICATION STATUS, indicate whether you are, or have ever been, licensed or certified to provide care, or if an application is pending. Include the type of license/certification, date licensed/certified, Licensing Agency details, and the license number.
8. For 7. OTHER ADULTS IN THE HOME, list the first, middle, and last names along with the relationship to you of all adults living in your home, excluding those under 18. Attach additional pages if more space is needed.
9. Complete and attach the form LIC 279B for 8. CURRENT CHILDREN IN YOUR HOME, detailing the name, date of birth, sex, and relationship of each child living in your home.
10. In the 9. TYPE OF LICENSE section, specify the capacity and age of children you plan to serve and the days and hours your home will be open.
11. Under 10. APPLICANT/LICENSEE RESPONSIBILITY, read and understand your responsibilities as an applicant/licensee, including living in the home, financial stability, safety equipment, compliance with laws, notification of changes, and more.
12. For the 11. PERJURY STATEMENT, every applicant must sign and date the form, affirming under penalty of perjury that the information provided is correct. Remember to check if all documents are signed and dated in ink and include the application/licensing fee.

After completing and verifying the LIC 279 form along with any supplementary documents and fees, submit the package to the requisite department as indicated in the application instructions. This diligent preparation and submission mark the beginning of the official journey to becoming a licensed family child care provider.

What is a LIC 279 form?

The LIC 279 form is an official document required by the California Department of Social Services Community Care Licensing Division. It is used for the application process to obtain a license to operate a family child care home. This form covers various application types, including new applications, changes in capacity or location, and updates to existing information.

Who needs to fill out the LIC 279 form?

This form must be filled out by individuals who plan to provide child care services in their home and wish to become licensed to do so. All applicants must be over the age of 18 and must reside in the home intended for child care.

What information is required on the LIC 279 form?

Applicants need to provide a range of information, including personal details, the type of application, home address, mailing address (if different), directions to the home, details about any previous licenses or certifications for child or adult care, information on other adults and children living in the home, the type of license applied for (small or large home), and various certifications concerning compliance with laws and regulations related to family child care homes.

Is an email address necessary for completing the LIC 279 form?

No, providing an email address on the LIC 279 form is not mandatory. However, including an email could facilitate easier communication with the licensing agency.

How do I indicate a change in capacity or location on this form?

If you're applying for a change in the licensed capacity of your family child care home or changing the location of your facility, you should check the respective box under "Type of Application" and provide the necessary information related to the change.

What happens if there is not enough space to provide all required information?

If you run out of space on the LIC 279 form while providing your information, you are allowed to attach additional sheets of paper. Make sure to indicate clearly which section your additional information corresponds to.

Can I complete the LIC 279 form online?

The instructions suggest that the form should be typed or printed clearly, which implies it needs to be downloaded, filled out, and then submitted in hard copy. Always check the most current requirements on the California Department of Social Services website or contact their office directly for the latest submission guidelines.

What is the importance of the perjury statement at the end of the LIC 279 form?

The perjury statement is a legal declaration that the information provided on the form is true and accurate to the best of the applicant's knowledge. Signing this declaration under penalty of perjury means that providing false information could result in legal consequences, including potential imprisonment.

How do I submit the completed LIC 279 form?

After completing the LIC 279 form, you should sign and date all required documents in ink, include the application/licensing fee if required, and mail or deliver them to the address provided by the Community Care Licensing Division. Always verify submission details since procedures may change.

Filling out the LIC 279 form for a Family Child Care Home License is a crucial step in starting or maintaining child care services in California. However, some common mistakes can hinder the application process. One such mistake is not providing complete information about the applicants. The form requires all applicants to be over 18 and live in the home that is to be licensed. Sometimes, individuals forget to check the box indicating their age or fail to mention all adults living in the home who have a role in child care. This oversight can lead to delays, as the Department of Social Services needs to ensure that everyone involved meets the criteria for providing child care.

Another critical area often overlooked is the section regarding the home's location and mailing address. Applicants sometimes enter the same information for their home and mailing addresses even when they differ. The LIC 279 form explicitly asks for a mailing address if it is different from the home address to ensure proper communication. It is also not uncommon for individuals to leave the email address blank, though providing it could facilitate faster and more direct communication with the licensing agency.

The mistake of not adequately detailing previous licenses or certifications held by the applicants is common too. The form requires information about any past or current licenses for caring facilities, including the type, date issued, and the licensing agency's contact information. When applicants fail to provide detailed information about their previous experiences or pending applications for child or adult care facilities, it may raise questions about their eligibility and background.

Moreover, failure to list all other adults living in the home, as required, is a significant oversight. The form asks for the names and relationships of all adults to ensure a safe and suitable environment for child care. Neglecting to mention any adult resident could result in a lack of trust and transparency between the applicants and the Department of Social Services, impacting the application's evaluation.

Finally, a common error is not accurately completing the section on the applicant/licensee responsibility. This section confirms understanding and commitment to compliance with laws and regulations, maintaining adequate facilities, and obtaining necessary approvals for changes. Incorrect or incomplete responses here can misrepresent the applicant's readiness and ability to adhere to state requirements, leading potentially to a refusal of the license.

All these mistakes can be avoided by carefully reviewing the LIC 279 form instructions and ensuring that every section is completed accurately and thoroughly. Doing so not only demonstrates professionalism and seriousness towards the child care vocation but also significantly smoothens the licensing process.

When applying for a family child care home license in California, using the LIC 279 form is just the beginning. This comprehensive document is your gateway to obtaining the license, but it's not the only paper that crosses the licensing agency's desk. Along with the LIC 279, there are several essential forms and documents that play a supporting role in the process. Each serves its unique function, contributing to a well-rounded application packet. Familiarizing yourself with these additional requirements can streamline your journey towards becoming a licensed family child care provider.

• LIC 279B - Current Children In Your Home: This form is referenced directly within the LIC 279. It requires the applicant to list the name, date of birth, sex, and relationship of each child living in the home. The information helps the agency understand who currently resides in the potential child care environment.
• LIC 508 - Criminal Record Statement: Every applicant and adult living in the home must complete this form, declaring whether they have ever been convicted of a crime. It's a crucial step for ensuring the safety of children in the care environment.
• LIC 9163 - Live Scan Fingerprinting: This document is related to background checks. It guides the applicant on how to get fingerprinted, which is necessary for the thorough vetting of anyone involved in child care services.
• LIC 9151 - Property Owner/Landlord Notification: For applicants renting or leasing their home, this form notifies the property owner about the intent to operate a family child care home. It’s a necessary step in ensuring all parties are informed and in agreement.
• LIC 9149 - Property Owner/Landlord Consent Form: This is a follow-up to LIC 9151, providing documented consent from the property owner for the use of the premises as a family child care home. It’s especially needed when expanding the capacity of the home.
• LIC 9108 - Child Abuse Reporting Requirements Acknowledgment: Applicants must acknowledge their understanding of the legal obligations to report known or suspected child abuse.
• LIC 610A - Physician’s Report – Child Care Centers (Staff and Residents): This form ensures that those living in and operating the family child care home are physically capable of providing safe and effective care.
• Emergency Disaster Plan: While not a standardized form like the others, developing an emergency disaster plan is required. It outlines the steps to be taken in case of an emergency to safeguard the well-being of children under care.

Gathering and completing these documents is a significant undertaking, but it is a necessary process to ensure the safety and well-being of children in family child care homes. Through detailed scrutiny and compliance with these requirements, prospective providers move closer to offering a nurturing and secure environment for children. Remember, each form and document adds a layer of trust and reliability to your application, making the path to licensure smoother and more assured.

The LIC 279 form, used for applying for a Family Child Care Home License in California, shares similarities with various other application forms across different sectors. One such form is the application for starting a new business. Similar to the LIC 279, a new business application requires detailed information about the business location, the type of business, and the applicant’s responsibilities. It also often includes sections where the applicant must affirm compliance with local laws and regulations, much like the LIC 279 form demands compliance with child care regulations.

Another document that bears resemblance to the LIC 279 is the foster care licensing application. This form, like the LIC 279, requires applicants to provide personal information, details about their residence, and any other individuals living in the home. It also involves a detailed checklist of safety and compliance measures that the applicant's home must meet, ensuring a safe environment for foster children, similar to how the LIC 279 form ensures the safety and compliance of family child care homes.

Applications for zoning permits can also be paralleled with the LIC 279 form. When seeking approval for land use, applicants must provide specific details about the intended use, location, and how it complies with local zoning laws. This process resembles the LIC 279’s requirement for applicants to demonstrate their home’s suitability for child care and compliance with relevant regulations.

The application process for a home-based business license shares similarities with the LIC 279 form as well. Applicants are required to describe the nature of the business, provide information about the home from which the business will operate, and ensure that they meet specific home-based business regulations. This is akin to describing the type of child care to be provided and ensuring the home meets child care licensing standards as required by the LIC 279 form.

Educational institution licensing applications also echo elements of the LIC 279 form. These applications often require detailed information about the institution's facilities, the capacity of students, and adherence to educational standards. Just like family child care home applicants, educational institutions must provide assurances and documentation to prove compliance with state requirements.

Professional certification applications, required for various professions, also bear resemblance to the LIC 279. These applications typically require personal information, proof of qualifications, and sometimes information about the applicant’s place of business. Similar to child care home licensing, professional certification ensures individuals meet set standards to provide safe and reliable services to the public.

Lastly, the application for a health department permit, necessary for businesses handling food, parallels the LIC 279 form in certain respects. Applicants must submit detailed information about their establishment, demonstrate compliance with health and safety standards, and sometimes provide information about the layout of the premises. This mirrors the LIC 279’s emphasis on safety and compliance within the home child care environment.

In summary, while the LIC 279 form is specific to family child care home licensing, its structure and requirements share commonalities with various other application forms across sectors, primarily focusing on personal information, safety, compliance, and regulatory adherence.

When applying for a Family Child Care Home License using the LIC 279 form, it’s crucial to pay attention to detail and follow certain dos and don'ts to ensure a smooth application process. Here is a comprehensive guide to assist you:

1. Read the entire form and accompanying instructions thoroughly before you start filling it out to make sure you understand every section.

2. Type or print clearly in ink to ensure all information is legible and can be understood by the licensing agency.

3. Check the appropriate boxes that apply to your situation, especially in sections where you must choose between options like "New Application" or "Capacity Change".

4. Provide your complete home address, as well as a mailing address if different, to avoid any communication delays or issues.

5. List all individuals living in your home, excluding children under 18, to give a clear understanding of the home environment.

6. Include directions to your home along with a sketch or map if necessary, to make it easy for the licensing agency to locate your residence.

7. Sign and date the form under the perjury statement to attest to the truthfulness of the information you've provided.

8. Attach additional paper if you need more space to provide complete answers or if you have more information that is required.

9. Ensure you have included the application/licensing fee with your submission, if required, to avoid delays in processing your application.

10. Check your application before submitting to ensure all required fields are filled and any necessary attachments are included.

1. Do not leave any required fields blank. If a section does not apply to you, write "N/A" to indicate this.

2. Avoid using pencil or any writing utensil that can be easily erased or smudged, as this can lead to issues with readability.

3. Do not forget to list any counties where you have lived in the past two years if you haven’t been residing in your current county for that duration.

4. Avoid assuming that email address is unnecessary - even though it’s marked as not required, providing it can facilitate faster communication.

5. Do not overlook the sections regarding the other adults and current children in your home, as omitting this information can result in an incomplete application.

6. Do not guess information related to any previous licenses or certifications; verify all details for accuracy before submitting.

7. Avoid making changes to your application after signing under the perjury statement without notifying the licensing agency of these amendments.

8. Do not submit the application without reviewing it for mistakes or missing information, as this can significantly delay the licensing process.

9. Avoid losing your copy of the completed form; always keep a copy for your records in case there are questions or follow-up needed.

10. Do not hesitate to ask for help if you encounter any difficulties while filling out the form. Assistance is available, and seeking it can help ensure the application is filled out correctly.

When it comes to understanding the intricacies of licensing for child care operations in California, the LIC 279 form is central. Yet, numerous misconceptions cloud its purpose and requirements. Let’s clear the air and address some of these misunderstandings.

• Only New Child Care Providers Need to Fill It Out: The LIC 279 is not solely for new child care providers. It is also designed for changes in capacity, location, or updates to existing information. Each of these situations requires the form to be completed and submitted to the appropriate authorities.

• Email Address is Mandatory: Despite common belief, the email address section of the LIC 279 form is optional. Applicants have the freedom to decide whether or not they wish to include this piece of information.

• Providing Home Directions is Optional: Clear directions to the home are actually necessary, as outlined in the application. This ensures that the licensing agency can locate and inspect the premises without issues. Attaching a map or sketch, although helpful, is optional.

• The Form Is Only For Family Child Care Homes: While it's tailored towards family child care homes, the LIC 279 encompasses licensing for both small (up to 8 children) and large (up to 14 children) operations, addressing diverse child care settings within private residences.

• No Financial Proof Is Required: Applicants must certify they have sufficient funds to maintain the home in accordance with legal standards. It’s a misconception that the form separates the financial aspect of running a child care from the licensing process. Financial viability is, in fact, an integral part of the application.

• Licensing Agencies Do Not Require Notice for Changes: Contrary to this belief, the form outlines the necessity to inform the licensing agency of any changes in license capacity or to the home itself. This ensures the agency is up-to-date with the current state and capacity of the child care facility.

• It’s Unnecessary to Inform Property Owners: If the home is leased or rented, applicants must indeed notify and obtain consent from the property owner for the purpose of operating a child care facility. This is a safeguard for both the property owner and the child care provider.

• Perjury Statement Is Just a Formality: The importance of the perjury statement at the end of the LIC 279 form shouldn’t be underestimated. By signing, applicants declare the accuracy and truthfulness of their provided information under penalty of perjury, emphasizing the seriousness of the application process.

Understanding these points about the LIC 279 form clarifies the path to compliance for family child care home providers, ensuring they meet the legal requirements to provide a safe and nurturing environment for children.

Filling out and using the LIC 279 form, an Application for a Family Child Care Home License in California, requires careful attention to detail and adherence to specific guidelines. Here are some key takeaways:

• Ensure Accuracy and Completeness: Applicants must type or print clearly when filling out the form to avoid any errors or misunderstandings. Every section should be completed to ensure the application process proceeds smoothly, with particular attention paid to personal information, home address, and licensing details.
• Understand the Types of Application: The form allows you to indicate whether you're applying for a new license, changing the capacity of an existing license, moving your location, or updating personal information. It's crucial to select the correct type to avoid processing delays.
• Include All Residents and Background Information: Listing all adults living in the home and providing a complete history of any other counties lived in over the past two years is required. This helps the licensing agency in its background checks and ensures compliance with safety regulations.
• Compliance with Health and Safety Standards: The application includes sections regarding safety equipment and practices, such as having a State Fire Marshal approved fire extinguisher and a smoke detector. Applicants must certify that their home meets these and other required standards for family child care homes.
• Legal Obligations and Perjury Statement: By signing the LIC 279 form, the applicant(s) declare under penalty of perjury that all statements and attachments are correct. Understanding the gravity of this declaration is important, as knowingly providing false information can lead to criminal charges. Thus, applicants must review all information for accuracy before submission.

Adhering to these key points ensures that the application process for a Family Child Care Home License is completed correctly and efficiently, laying a solid foundation for operating a licensed child care home in California.