Family child care uses the LIC series. LIC 311D separates records retained at home from application submissions.
Agency: California Department of Social Services, Community Care Licensing Division Paperwork source review: September 14, 2026
Use your print window to print on paper or save as a PDF. The organizer is a planning aid for your files.
Check the form and your provider type.
An official agency form is issued or listed by the agency; that label alone does not establish mandatory use. A required state form is identified as mandatory in the cited instructions. A required record identifies information you must maintain; its format may be flexible. An optional template is a suggested format. Official instructions / portal links explain the application or record process.
Read “Applies to” and “Format and applicability” for each item. Home, group-home, center, local licensing, food-program, and subsidy requirements can differ.
Application & renewal
01
Official agency form
Family Child Care Home License Application
Form LIC 279
Request initial license, capacity/location change or update.
Applies to
Small and large family child care homes
Who completes it
Applicant
Where it goes
Regional licensing office; follow current application instructions.
When to use or update
Before opening or proposed licensed change.
Format and applicability: Three-page PDF, February 2023.
Forms/Records to Keep in Your Family Child Care Home
Form LIC 311D
Checklist of child, staff and facility files for inspection.
Applies to
Family child care homes
Who completes it
Licensee
Where it goes
Keep applicable records at home; do not send checklist records with application.
When to use or update
Prepare for prelicensing visit and ongoing inspections.
Format and applicability: Two-page guidance checklist; conditional items apply only when relevant.
Open official source: LIC 311D ↗https://www.cdss.ca.gov/Portals/9/Additional-Resources/Forms-and-Brochures/2020/I-L/LIC311D.pdf?ver=2022-08-10-140050-717
03
Official agency form
Identification and Emergency Information
Form LIC 700
Record emergency contacts, medical contacts and authorized pickup people.
Format and applicability: Use both pages; LIC 311D identifies this record for every child.
Open official source: LIC 700 ↗https://www.cdss.ca.gov/Portals/9/Additional-Resources/Forms-and-Brochures/2019/I-L/LIC700.pdf?ver=2019-10-24-143032-763
07
Required record
Child Care Facility Roster
Form LIC 9040
Maintain a current roster of enrolled children and family and medical contacts.
Applies to
Family child care homes and child care centers
Who completes it
Licensee or program administrator
Where it goes
Keep centrally at the facility; make available to licensing on request.
When to use or update
Update as enrollment or contact information changes. The official form states three-year retention.
Format and applicability: Required information; this exact state template is optional. A permitted alternative must contain the required roster information.
Emergency Disaster Plan for Family Child Care Homes
Form LIC 610A
Plan evacuation, relocation, utilities and emergency contacts.
Applies to
Family child care homes
Who completes it
Licensee
Where it goes
Post near phone; send copy with application to licensing office.
When to use or update
Application and when information changes.
Format and applicability: Two-page PDF; coordinate evacuation with LIC 999A sketch.
Open official source: LIC 610A ↗https://www.cdss.ca.gov/Portals/9/Additional-Resources/Forms-and-Brochures/2020/I-L/LIC610A.pdf?ver=2022-02-03-161333-933
05
Required record
Unusual Incident/Injury Report—Family Child Care Home
Form LIC 624B
Report listed serious incidents and corrective action.
Applies to
Family child care homes with reportable events
Who completes it
Licensee
Where it goes
Licensing office; copy in affected child’s record.
When to use or update
Parents same business day; agency next business day; written report within seven calendar days if initially telephoned.
Format and applicability: Two-page PDF; separate abuse-reporting duties also appear.
Route fingerprints to correct agency and facility.
Applies to
People undergoing Community Care Licensing background checks
Who completes it
Applicant and fingerprint operator
Where it goes
Bring to Live Scan service; retain transaction documentation.
When to use or update
When instructed to complete background clearance.
Format and applicability: Six-page form/instructions/privacy notice; use assigned facility/OCA number.
Open official source: LIC 9163 ↗https://www.cdss.ca.gov/Portals/9/Additional-Resources/Forms-and-Brochures/2020/I-L/LIC9163.pdf?ver=bjvlePFphOnuNbE5s31iCA%3D%3D
What this review covers
Selected official forms and public instructions were reviewed on September 14, 2026. This is a practical starting list, not a complete certification of every record, retention period, local rule, or individual application.
LIC 701 Physician’s Report is labeled for centers and is not presented here as a family-home requirement.
CACFP and subsidized attendance requirements vary by participation and contracting agency; not established by these licensing forms.
Use the agency’s current original and revision instructions. Keep confidential child and staff records in your own secure record system.
Use this sheet to check which items apply to your program. A listed item or a checked box does not establish that your program meets licensing requirements.
Program / provider type:
Licensing office / reviewer:
Date checked / rule or packet edition:
Form or instruction
Applies? Yes / No / Ask
Received / completed
Location / next review
1. Family Child Care Home License Application (LIC 279)
2. Forms/Records to Keep in Your Family Child Care Home (LIC 311D)
3. Identification and Emergency Information (LIC 700)
4. Emergency Disaster Plan for Family Child Care Homes (LIC 610A)
5. Unusual Incident/Injury Report—Family Child Care Home (LIC 624B)
6. Request for Live Scan Service (LIC 9163)
7. Child Care Facility Roster (LIC 9040)
Other local or agency document
Food-program / subsidy documents
Questions and next steps
Ask about required format, signatures, submission, update triggers, and retention. Record the agency’s answer and the person or written source that confirmed it.
Companion to the California source review dated September 14, 2026. Provider Path educational planning sheet.
Use your existing tools alongside these sources.
Keep official licensing records with your program’s business records. Provider Path’s editable agreement, handbook, and daily forms can help organize your work; check the state instructions before choosing a format.
