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Fill Out Your Lic 200A Form

The Lic 200A form is an essential application used to obtain a license for operating a child care center in California. This form must be completed accurately to ensure compliance with state regulations and to facilitate the approval process. For those ready to take the next step, fill out the Lic 200A form by clicking the button below.

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For those looking to establish a child care center in California, the Lic 200A form is an essential piece of paperwork that serves as the application for a child care center license. This comprehensive form requires specific details about the applicant, including the names and addresses of those responsible for the facility, as well as the type of action being taken—whether it’s an initial application, a change of ownership, or other modifications. Information about the facility itself is critical as well, encompassing its address, capacity, and hours of operation. Additionally, applicants must clarify the facility type, and specify whether they will cater to infants, toddlers, or school-age children. Understanding the responsibilities associated with operating the facility is another key aspect of this form. By signing the Lic 200A, the applicant commits to complying with health and safety regulations, ensuring fingerprint requirements for employees are met, and acknowledging the right to appeal any decisions made by the licensing agency. This form serves as a vital step in the journey toward providing quality child care, setting the foundation for both legal compliance and the safety of the children who will attend the facility.

Lic 200A Example

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES

APPLICATION FOR A CHILD CARE CENTER LICENSE

(See Instructions on Back)

FOR DEPARTMENT USE ONLY

DISTRICT:
COUNTY:			FACILITY NUMBER:
DATE:			ACTION TYPE:
REVIEWED BY:			FACILITY TYPE:

1.	APPLICANT(S) NAME(S)	(please print)

REPLY TO:

2.REQUESTED ACTION (CHECK ONE):

■ A. INITIAL APPLICATION

■ E. CHANGE OF OWNERSHIP

■B. CHANGE OF CAPACITY ■ F. CHANGE WITHIN CORPORATION

■C. CHANGE OF LOCATION ■ G. OTHER (E.G., TODDLER OPTION,

■ D. CHANGE OF FACILITY TYPE

COMBINATION CENTER, ETC.)

APPLICANT ADDRESS

CITY

STATE

ZIP CODE

AREA CODE/TELEPHONE

(

)

APPLICATION

INDIVIDUAL

PARTNERSHIP

NON PROFIT CORP.

PROFIT CORP

FILED BY:

COUNTY

OTHER PUBLIC AGENCY

LIMITED LIABILITY COMPANY

FACILITY/AGENCY NAME

EMAIL (NOT REQUIRED)

AREA CODE/TELEPHONE

(

)

FACILITY ADDRESS

CITY

COUNTY

ZIP CODE

ALTERNATIVE PUBLIC TELEPHONE

(

)

MAILING ADDRESS

CITY

STATE

ZIP CODE

PERSON IN CHARGE OF FACILITY

TITLE

TYPE OF FACILITY

10.

REQUESTED

AGE

11.

IF PROVIDING CARE TO NON-AMBULATORY

CAPACITY:

RANGE:

CHILDREN, CHECK HERE:

■

INFANT CARE CENTER

■ D.

INFANT

_________

CHILD CARE CENTER FOR MILDLY ILL CHILDREN

■ CHECK HERE FOR TODDLER OPTION

TODDLER OPTION

_________

■ E.

COMBINATION

PRESCHOOL

_________

NUMBER OF NON-AMBULATORY ___________

■

(CHECK APPROPRIATE BOXES FOR COMBINATION

SCHOOL-AGE

_________

CHILD CARE CENTER (PRE-SCHOOL)

12.

DAYS AND HOURS OF OPERATION:

CENTER)

(IF A COMBINATION CENTER IS CHECKED, ENTER

MILDLY ILL

_________

■ CHECK HERE FOR TODDLER OPTION

■ F.

DAYS AND HOURS FOR EACH COMPONENT.)

OTHER (SPECIFY)

■

SCHOOL-AGE CENTER

TOTAL CAPACITY

_________

13.

PROPERTY OWNERSHIP:

■ OWN

■ RENT

■ OTHER (SPECIFY) __________________________________________________________________________________

13A.

IF RENTING OR LEASING, NAME, ADDRESS AND PHONE NUMBER OF PROPERTY OWNER,:

14.

WAS FACILITY PREVIOUSLY LICENSED? IF YES, FACILITY NAME AND NUMBER:

LICENSING AGENCY NAME:

■YES ■ NO

15. IS MAJOR CONSTRUCTION REQUIRED?		DATE CONSTRUCTION TO BEGIN: _____________________________________________	16. SOURCE OF WATER FOR HUMAN CONSUMPTION

■ YES	■ NO	DATE TO BE COMPLETED: ___________________________________________________	■ PUBLIC ■ PRIVATE

17.NAME AND FACILITY NUMBER OF OTHER COMMUNITY CARE, CHILD CARE, RESIDENTIAL CARE FACILITIES FOR THE ELDERLY, OR HEALTH FACILITIES LICENSED TO OR OWNED BY APPLICANT(S) WITHIN THE LAST FIVE YEARS;

A.	B.	C.

D.	E.	F.

18.APPLICANT(S)/LICENSEE(S) RESPONSIBILITIES:

A.IN ADDITION TO COMPLYING WITH THE HEALTH AND SAFETY CODE AND REGULATIONS APPLICABLE TO LICENSING AND FIRE SAFETY, I/WE UNDERSTAND THAT THERE MAY BE OTHER STATE, FEDERAL AND/OR LOCAL LAWS WHICH ARE NOT ENFORCED BY THIS AGENCY BUT THAT MAY NEED TO BE MET, SUCH AS ZONING, BUILDING, SANITATION AND LABOR REQUIREMENTS.

B.I/WE HAVE READ AND UNDERSTAND THE STATUTES AND REGULATIONS THAT PERTAIN TO MY/OUR LICENSING CATEGORY PRIOR TO THE ISSUANCE OF MY/OUR LICENSE.

C.I/WE SHALL ENSURE THAT ALL PERSONS SUBJECT TO FINGERPRINT REQUIREMENTS SHALL HAVE A DEPARTMENT OF JUSTICE CLEARANCE OR A CRIMINAL RECORD EXEMPTION PRIOR TO EMPLOYMENT, RESIDENCE OR INITIAL PRESENCE IN THE FACILITY AS REQUIRED.

D.I/WE SHALL ENSURE THAT ALL PERSONS SUBJECT TO FINGERPRINT REQUIREMENTS SHALL ALSO SUBMIT A CHILD ABUSE INDEX CHECK FORM TO THE DEPARTMENT OF JUSTICE.

E.I/WE SHALL NOTIFY THE LICENSING AGENCY IMMEDIATELY IF A PERSON SUBJECT TO FINGERPRINTING REQUIREMENT, IS CONVICTED OF A CRIME AFTER EMPLOYMENT.

F.I/WE SHALL OBTAIN APPROVAL FROM THE LICENSING AGENCY PRIOR TO MAKING ANY CHANGE(S) THAT AFFECT THE TERMS OF THE LICENSE.

19.I/WE UNDERSTAND THAT I/WE HAVE THE RIGHT TO APPEAL ANY DECISION REGARDING THE DISPOSITION OF THIS APPLICATION.

20.I/WE DECLARE UNDER PENALTY OF PERJURY THAT THE STATEMENTS ON THIS APPLICATION AND ON THE ACCOMPANYING ATTACHMENTS ARE CORRECT TO THE BEST OF MY/OUR KNOWLEDGE.

SIGNED _____________________________________________________ TITLE ________________________________________ COUNTY WHERE SIGNED ______________________________ DATE_________________

LIC 200A (6/08)

PAGE 1 OF 2

INSTRUCTIONS FOR APPLICATION FOR A CHILD CARE CENTER LICENSE

Type or print clearly. Prepare application in duplicate. Return original.

1.Applicant(s): Enter the name(s) of the person(s) or organization legally responsible for the facility. Enter full names. Individuals enter first, middle and last name. If joint application, all applicants must sign this application. Individuals, each partner, and chief executive officer or authorized representative of a firm, association, corporation, county, city, public agency or governmental entity must complete Applicant Information (LIC 215). Corporations and other organizations also complete Administrative Organization, (LIC 309).

2.Requested Action: Check appropriate box.

3.Applicant Address: Enter legal home address of individual(s) and headquarters address of corporations. Major partner enters principal business address. Other partners enter principal business address on Applicant Information (LIC 215). Enter area code with telephone number.

4.Application Filed by: Check appropriate box.

5.Facility/Agency Name: Enter the name used to designate the single facility under application. If an agency, fill in the name of the agency which provides the services and hyphenate the single facility name, e.g., YMCA-Peppertree Day Care School.

6.Facility Address: Enter the address of the physical location of the facility. If applicant has more than one facility, a separate application must be completed for each facility. Enter area code with telephone number.

7.Mailing Address: Enter the address where all mail from the department/licensing agency should be sent.

8.Person in Charge of Facility: Enter the name and title of person who will directly supervise the facility. If not yet employed, enter “Unknown.”

9.Type of Facility: Check the appropriate box for type of facility as defined in California Code of Regulations, Title 22.

10.Requested Capacity and Age Range: Enter the total number of children and age range for whom care will be provided at any time.

11.Check box and enter number of non-ambulatory children for which you are providing care.

12.Days & Hours of Operation: Enter days and hours of operation of facility.

13.Property Ownership: Check the appropriate box.

13A. Control of Property: If applicant(s) is leasing or renting, enter name, address and phone of owner of facility premises.

14.Was Facility Previously Licensed? Check YES or NO. If yes, enter facility name, number and name of agency which issued license(s).

15.Is Facility to be Constructed or Require Major Building Change? Self-explanatory.

16.Source of Water for Human Consumption: Check PUBLIC or PRIVATE water source.

17.Other Facilities: Enter the facility name and number of any other community care or health facilities owned or operated by applicant(s).

18.Statement of applicant(s)/licensee(s) responsibilities of compliance with all applicable laws and regulations.

19.Acknowledgement of right to appeal.

20.Signatures of all applicants or authorized person(s) (e.g., general partners of a partnership and executive officer or duly authorized representative for all corporations, public agencies, etc.).

LIC 200A (6/08)

PAGE 2 OF 2

Get Lic 200A PDF Form

Form Characteristics

Fact Name	Description
Purpose of the Form	The LIC 200A is the application form required to obtain a license for a child care center in California.
Governing Law	This form operates under the California Health and Safety Code, specifically Title 22 regulations pertaining to child care facilities.
Types of Applications	Options on the form include initial application, change in ownership, change of capacity, or change in facility type, among others.
Applicant Information	Applicants must provide their names and addresses, along with the facility's name and location.
Facility Type	The form allows identification of various facility types, such as infant care or school-age centers.
Mandatory Requirements	Applicants must ensure compliance with local, state, and federal regulations related to safety, zoning, and labor.
Right to Appeal	Applicants reserve the right to appeal any decision made regarding their application for licensing.

Guidelines on Utilizing Lic 200A

Completing the Lic 200A form is an essential process for those seeking to obtain a Child Care Center License in California. Following the steps outlined below will help ensure that all necessary information is captured accurately and altogether, it contributes to a smoother application process and expedites the review by regulatory authorities.

Applicant(s) Name(s): Clearly print the full name(s) of the individuals or organizations responsible for the facility. If it’s a joint application, ensure that all applicants sign.
Requested Action: Check the box that corresponds to what you are applying for—be it an initial application, change of ownership, or another option.
Applicant Address: Provide the legal home address for individuals and the headquarters address for corporations. Include the area code with the telephone number.
Application Filed By: Indicate the type of entity filing the application by checking the appropriate box.
Facility/Agency Name: Enter the specific name designated for the facility you are applying for. If it operates under an agency, include that agency's name, connected by a hyphen.
Facility Address: Supply the actual address of the facility location. Remember to include the area code in the telephone number.
Mailing Address: Provide the address where communications from the department should be directed.
Person in Charge of Facility: Fill in the name and title of the individual responsible for overseeing operations. If yet to be hired, indicate “Unknown.”
Type of Facility: Select the appropriate type of facility based on the definitions provided in the regulations.
Requested Capacity and Age Range: Enter the total number of children the facility can accommodate, along with the age range of those children.
Non-Ambulatory Children: If applicable, check the box to indicate care for non-ambulatory children and provide the necessary details.
Days and Hours of Operation: Clearly state the days and hours during which the facility will operate.
Property Ownership: Indicate whether you own, rent, or have another arrangement regarding the property.
Property Owner Information: If renting, include the owner’s name, address, and contact number.
Previous Licensing: State whether the facility has been previously licensed. If so, provide relevant details.
Construction Requirements: Specify if major construction is needed for the facility.
Water Source: Check whether the source of water for consumption is public or private.
Other Facilities: List any other community care or health facilities owned or operated by the applicant within the last five years.
Responsibilities Acknowledgment: Review and acknowledge that you understand the responsibilities associated with the application as outlined.
Right to Appeal: Confirm that you are aware of your right to appeal decisions regarding your application.
Signatures: Ensure that all required applicants or authorized individuals sign the application.

Once the form is accurately completed and submitted, it will be reviewed by the licensing authority. They will assess the application based on the provided information, and any required follow-up or additional documentation will be requested as necessary. Being meticulous in this process often results in expedited approvals and minimizes delays.

What You Should Know About This Form

What is the Lic 200A form and what is its purpose?

The Lic 200A form is the application for a Child Care Center License in California. This document is essential for individuals or organizations seeking to operate a child care facility. By filling out this form correctly, applicants provide the state with necessary details about their facility, ensuring compliance with safety and regulatory standards. It's your first step toward creating a safe environment for children in your care.

Who needs to fill out the Lic 200A form?

The Lic 200A form must be completed by anyone applying for a child care center license in California. This includes individuals, partnerships, non-profit and profit corporations, and other public agencies. If you are responsible for overseeing a child care facility and wish to obtain or change your current license status, this form is necessary. Each applicant must provide accurate and detailed information to expedite the review process.

What information is required on the Lic 200A form?

To complete the Lic 200A form, you need to supply several key pieces of information. This includes the applicant's names and addresses, the facility's name and address, details about the type of facility, requested capacity, and the days and hours of operation. Additionally, you will need to indicate any change of ownership or facility type, if applicable. Providing complete and accurate information is crucial for the timely processing of your application.

How long does it take to process the Lic 200A application?

The processing time for the Lic 200A application can vary. On average, it may take several weeks for the department to review and respond to your application. Delays can occur if the application lacks necessary information or if inspections are required. Therefore, it's important to carefully review your application before submission to avoid any setbacks. Prompt submission is advisable to ensure your facility can begin operations as soon as possible.

Can I appeal a decision made regarding my Lic 200A application?

Yes, applicants have the right to appeal any decision related to the Lic 200A application. If your application is denied or you receive unfavorable feedback, you can formally contest that decision. It's important to understand the specific appeal process provided by the licensing agency. Act quickly, as there may be deadlines involved in submitting your appeal; staying informed can make a significant difference.

What should I do if I need to make changes after submitting the Lic 200A form?

If any changes need to be made after you have submitted the Lic 200A form, you must notify the licensing agency immediately. Certain changes, such as alterations to the facility type, ownership, or capacity, may require additional approvals. Communication is key here; proactively informing the agency of changes can help maintain compliance with licensing regulations. Being transparent can save you considerable time and effort down the road.

Common mistakes

Filling out the Lic 200A form for a Child Care Center License is a crucial process that requires attention to detail. One common mistake occurs when applicants do not provide complete names for themselves or their organization in the Applicant(s) Name(s) section. It is vital for individuals to enter their full names, including first, middle, and last names. If it's a joint application, all parties need to sign the application. Leaving out any part of the name can lead to processing delays.

Another frequent error happens in the Requested Action section. Applicants sometimes forget to check the appropriate box that indicates their desired action—whether it's an initial application, a change, or another option. Failing to make this selection could result in misunderstandings about the applicant’s intentions, which may complicate the review process.

In addition, filling out the Applicant Address can also pose challenges. Some individuals provide addresses that are not their legal home address or fail to include the area code with their telephone number. It is critical that the address listed is accurate and complete since this is where important communications from the licensing agency will be sent. Any discrepancies can lead to missed notifications and subsequent delays in obtaining the license.

Lastly, applicants often neglect to specify the Type of Facility they are applying for. This section requires checking the appropriate box that defines the facility according to California regulations. Incorrectly identifying the facility type can result in the application being processed under the wrong guidelines, leading to potential compliance issues later. Thoroughly reviewing each section of the form before submission can help mitigate these common mistakes.

Documents used along the form

The Application for a Child Care Center License (Lic 200A) is just one part of the process. Alongside this form, there are several other documents that may also be necessary. These documents help ensure that your application is complete and compliant with state regulations. Here’s a brief overview of some key forms you might encounter.

LIC 215 - Applicant Information: This form collects information about the individual or organization responsible for the childcare center. It includes details such as names, addresses, and contact information for all applicants.
LIC 309 - Administrative Organization: Required for corporations or groups, this form outlines the structure of the organization, detailing the roles of officers and significant partners involved in the operation of the facility.
LIC 9227 - Child Care Center Self-Assessment: This self-assessment tool helps applicants evaluate if their facility meets specific health and safety standards before submitting their application.
LIC 508 - Disaster Plan: This document outlines the emergency response plan for the childcare center. It's essential for ensuring the safety of children and staff in case of emergencies.
LIC 9150 - Fire Safety Clearance: A fire safety inspection report that shows the facility has been evaluated and approved by the fire department, ensuring it meets fire safety regulations.
LIC 995 - Lead Exposure Notice: If applicable, this form provides information about potential lead exposure in the childcare environment and what steps can be taken to mitigate risks.
Background Check Documentation: This includes forms required for fingerprinting and criminal checks, ensuring that staff and volunteers meet safety standards before working with children.
Proof of Insurance: A copy of liability insurance that covers the childcare operations, demonstrating that the center can handle potential claims or liabilities.

Gathering these documents can help your application process go smoothly. Each form plays a pivotal role in establishing the legitimacy and safety of your childcare center, fostering trust among parents and regulatory agencies alike. Always ensure everything is complete and accurate before submission to avoid delays in the licensing process.

Similar forms

The LIC 200A form is essential for applying for a childcare center license in California. This form has similarities to several other important documents in the licensing and regulatory process. Here are six documents that are comparable to the LIC 200A, along with specific ways they are alike:

LIC 215 - Applicant Information: Both forms require detailed information about the applicant(s), including names and addresses, ensuring that the licensing authority has clear identification and contact details.
LIC 309 - Administrative Organization: This document outlines the organizational structure of the facility. Likewise, the LIC 200A asks about the applicant's entity type and responsibilities, providing vital insights into management.
LIC 500 - Child Care Center Application for License: Similar to the LIC 200A, the LIC 500 is another application form used for obtaining a childcare facility license, emphasizing compliance with health and safety regulations.
LIC 602 - Personnel Report: Both forms require background information about individuals involved in the operation of the childcare facility, including compliance with fingerprinting and background checks.
LIC 9102 - Community Care Licensing Initial Application: This application serves a similar purpose but for various types of community care facilities. Like the LIC 200A, it requires an understanding of applicable laws and direct oversight obligations.
LIC 9227 - Statement of Facilities: This document also gathers information regarding the physical location and operational aspects of a facility, paralleling the data collection in the LIC 200A related to facility address and capacity.

Dos and Don'ts

When filling out the Lic 200A form for a Child Care Center License, it’s important to pay attention to how you complete it. Below are some guidelines on what you should and shouldn’t do.

Do type or print clearly. Ensure that all information is legible to avoid any delays in processing.
Don't leave any sections blank. Every question must be answered, even if it is not applicable; you can mark it as N/A.
Do provide complete names and addresses. Full names and legal addresses are necessary for accurate identification.
Don't use abbreviations or nicknames. Use the full names of organizations and individuals.

Following these tips will help ensure your application is completed correctly and can expedite the licensing process. Paying attention to details is essential in legal forms, as any errors can lead to delays or rejections.

Misconceptions

Misconception 1: The Lic 200A form is only for initial applications.

This form can be used for various actions, including changes of ownership, capacity, location, and other modifications. It supports both new applications and adjustments to existing licenses.
Misconception 2: Everyone applying can use the same Lic 200A form regardless of their facility type.

The form requires applicants to specify the type of facility, such as infant care or school-age center. Different facility types may have unique requirements and sections in the application.
Misconception 3: Filling out the Lic 200A form guarantees a license.

Submitting the form does not automatically result in a license being granted. The application will undergo a review process, and compliance with health and safety regulations is essential.
Misconception 4: Only the facility owner must be involved in the application process.

All individuals or organizations legally responsible for the facility must sign the form. This includes partners and representatives, ensuring that everyone is aware of and agrees to the application details.

Key takeaways

Key Takeaways for Filling Out and Using the Lic 200A Form

The Lic 200A form must be accurately completed with clear, printed information regarding the applicant(s), facility type, and requested action. It is essential to ensure that all names and addresses are entered correctly to avoid processing delays.
Applicants must check the appropriate boxes to indicate the requested action, such as an initial application or a change of ownership. Understanding which option applies to your situation will help streamline the application process.
It is important to note that all persons subject to fingerprint requirements must obtain clearances before employment or residence in the facility. This responsibility is crucial for maintaining compliance with licensing regulations.
Finally, applicants should be aware of their right to appeal any decisions made regarding their application. This provision allows for transparency and fairness in the licensing process, providing an avenue for recourse if necessary.

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