Ccld lic 9163. Enter this facility type on this line.



Ccld lic 9163. LIC 9163 (3/11) PAGE 3 OF 4 Instructions for the LIC 9163 Originating Response lndicator (ORl): Preprinted Working Title: Check the appropriate box Authorized Applicant Type: Indicate the facility type where you will be working. For questions about this notice, CDSS programs, and the authorized use of your criminal history information, please contact your local licensing regional ofice. If you use a Live Scan Operator other than IBT - L1, you will need to take 2 copies of this form. One copy will be retained by the Operator and the other you may retain for your records. If the Live Scan Operator is IBT - L1, they will return the completed form to you. Retain this form for your records. May 19, 2025 · The California DOJ charges a government fee specific to each CCLD Facility Type. Instructions for the LIC 9163 Originating Response Indicator (ORI): Preprinted Working Title: Check the appropriate box Authorized Applicant Type: Indicate the facility type where you will be working. Bring a valid photo ID and payment method to your appointment; same-day appointments are accepted. Select one of the following: For CCLD applicants, check: For TrustLine applicants, check: A0448 A1157 Type of Application: Check the appropriate box. Assistance is available for filling Instructions for the LIC 9163 Originating Response lndicator (ORl): Preprinted Working Title: Check the appropriate box Authorized Applicant Type: Indicate the facility type where you will be working. May 19, 2025 · The Live Scan fingerprinting fee varies based on the facility or job type for CCLD applicants. Applicants must complete the LIC 9163 form and bring two copies for fingerprinting. Instructions for the LIC 9163 Originating Response Indicator (ORI): Enter the CCLD or TrustLine ORI code below that pertains to you. The California DOJ charges a government fee specific to each CCLD Facility Type. . For Applicants using a CCLD Live Scan Site: Select your CCLD facility type from the left column in the table below. Enter this facility type on this line. LIC 9163 (12/15) Amount Collected/Billed PAGE 1 OF 4 GUIDELINES FOR COMMUNITY CARE LICENSING (CCLD) APPLICANTS WHO USE A LIVE SCAN SITE (CCLD or DOJ SITE) FOR FINGERPRINTING LIC 9280 (10/21) - Pre-licensing Entrance Checklist - Family Child Care Homes LIC 9282 (6/23) – Residential Infection Control Plan - Adult Residential Facilities, Enhanced Behavioral Supports Homes, Community Crisis Homes, Residential Care Facilities for the Elderly, Residential Care Facilities for the Chronically Ill, and Social Form LIC 9163 is used to request Live Scan services for individuals seeking employment or volunteer positions in community care licensing programs in California. GUIDELINES FOR COMMUNITY CARE LICENSING (CCLD) APPLICANTS WHO USE A LIVE SCAN SITE (CCLD or DOJ SITE) FOR FINGERPRINTING Instructions for the LIC 9163 Originating Response Indicator (ORI): Preprinted Working Title: Check the appropriate box Authorized Applicant Type: Indicate the facility type where you will be working. lcl o3mval dn9 qnn mye1d lfdf joxs rgfa 1ry zm2u3