If your clearance status is active and clear, you do not need to submit prints again.
To find out if you are active and in the system contact the local CCL office and ask to check your clearance status. If clear, the office staff will give you your LIS personnel number and status. If you are clear and active, write a note with your application that you are clear along with your LIS Personnel number and clearance status.
You will still need to complete the Request for Live Scan Form LIC 9163 even if you are clear and current.
How to complete the Request for Live Scan Form LIC 9163 for new administrators who already have criminal record clearance with an existing facility.
Box 1: ORI – The CCLD ORI number is A0448, usually preprinted on the form.
Box 3: Applicant Type - Identify the type(s) of facility for which you are being
certified (e.g., ARF, GH, RCFE).
Box 4: Agency Section - Make no changes to preprinted info.
Box 5: Applicant Information – Add your personal information, etc.
Box 6: Facility Number - If you are currently working at a facility, or have been
hired by a facility, list the facility’s license number. You can locate the number of the facility by doing a search here.
Box 7: Employer - If you are currently working at a facility, or have been hired by
a facility, list the facility’s name and address.
You may also include a paper copy of your clearance if you have one.
Send in your completed Live Scan form LIC 9163 along with your Administrator Application.
Check the pending list to say the status of your application.
If you want more information re your application process contact the ACS section:
Community Care Licensing Division
Administrator Certification Section
744 P Street, MS 9 -17- 47
Sacramento, CA 95814
916-653-9300
[email protected]
