LIC 200: Application

LIC 200 - Application for a Community Care Facility or Residential Care Facility for the Elderly License.

This is the Application Form that a prospective RCFE Licensee must complete as part of the process to obtain a license to operate an RCFE. This form requires information about facility location, organization type, facility ownership, property ownership, as well as information about what type of facility the applicant wishes to open (i.e. type of clients served, total number of residents, and whether the clients will be ambulatory, non-ambulatory, etc.).  

After licensure, this form is used to request an increase in capacity, request a change of ownership, or request approval to provide additional services. 
 

If CARR has a scanned LIC 200 for an individual facility, it will be shown as a document icon, identified as LIC200.

To view:  http://www.dss.cahwnet.gov/cdssweb/entres/forms/English/LIC200.pdf