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LIC 9182: Criminal Background Clearance Transfer Request

By Sevana Care · Checked against cdss.ca.gov and Title 22 on

When it is due
Before the person's first presence in the home.The form says the request "must be submitted to the Department before the individual who is the subject of the transfer has initial presence in the facility/organization" or the home "will be in violation of the law and may be subject to a $100 civil penalty" [1]. CDSS adds that the person "need not wait for a confirmation of the transfer" to begin work [7].
Who fills it out
A licensee or license applicant submits it [3].The licensee verifies the person's identity, and the licensee, administrator or director signs the certification on page 2 [1]. Regional office staff fill in the box marked "For regional office use only" [1].
Where it is kept
The form says to submit it to "your licensing office" [1].Under the heading "FOR REGIONAL OFFICE USE ONLY" the form prints "FILE IN NEWLY ASSOCIATED FACILITY/ORGANIZATION FILE"; it does not say who that line is for [1]. Title 22 asks the home to keep documentation of the clearance or exemption in the personnel file and does not name this form [3][5].
How long to keep
The form gives no period [1].Section 87412(h) sets three years after employment ends for personnel records, and § 87412 does not name LIC 9182 [5].

LIC 9182 is the California Department of Social Services (CDSS) form a licensee or license applicant uses to ask CDSS to move a person's active criminal record clearance from one eligible state-licensed facility to another [1]. Title 22 § 87355(c)(1) names it, as "LIC 9182 (Rev. 4/02)" [3]. Health and Safety Code (HSC) § 1569.17(g)(1) says the request "shall be submitted to the department on a form provided by the department or submitted via the department's secure online portal" [6].

Who fills it out

Section 87355(c) says "A licensee or applicant for a license may request a transfer of a criminal record clearance from one state licensed facility to another, or from TrustLine to a state licensed facility" by providing documents to the Department [3]:

  • a signed LIC 9182
  • a copy of the person's driver's license, a DMV identification card, or a valid photo identification from another state or the United States government if the person is not a California resident
  • "Any other documentation required by the Department"; the rule gives examples

The form says to "type or print clearly and complete all fields unless marked voluntary." It also says "Please complete one form for each facility number" [1]. The form asks for [1]:

  • the person's name, California driver's license or ID number or permanent resident ID, and date of birth
  • a Licensing Information System ID, background check number or application number
  • the Social Security number, marked voluntary
  • the facility the person is now tied to, and the facility the clearance goes to, with its number, street address and the date of employment
  • the transferee association type, with boxes including Certified Administrator, Employee/Volunteer, Licensee/Applicant and Non-client Adult Resident

The licensee signs for identity. The form says "The licensee must verify the identity of the applicant who is seeking the clearance transfer, if applicable." The certification reads "I certify I have verified the above individual's identity," with title (licensee, administrator or director), signature, printed name and date [1]. HSC § 1569.17(g)(1) says "Upon request of the licensee, who shall verify the individual's identity, the department shall verify whether the individual has a clearance that can be transferred" [6].

Who it covers. The form "may only be used to request a clearance transfer between eligible state licensed facilities/organizations/homes." For a transfer between county and state licensed facilities, "the requesting Licensing Agency must contact their county liaison" [1].

When it is due

Before the person's first presence in the home. The form says: "The transfer request must be submitted to the Department before the individual who is the subject of the transfer has initial presence in the facility/organization, or the facility/organization will be in violation of the law and may be subject to a $100 civil penalty" [1]. Section 87355(e) lists what a person shall do "prior to working, residing or volunteering in a licensed facility." One of the listed choices is to "Request a transfer of a criminal record clearance as specified in Section 87355(c)" [3]. Section 87411(g) says the same "Prior to employment or initial presence in the facility" [4]. HSC § 1569.17(c)(1)(A) has the licensee submit fingerprints "or to comply with paragraph (1) of subdivision (g) prior to the person's employment, residence, or initial presence in the residential care facility for the elderly" [6].

No wait for the answer. CDSS says: "An individual need not wait for a confirmation of the transfer before he/she can begin work or be present in the facility" [7].

No new fingerprints. CDSS says: "If an individual has an active clearance, he/she should not be re-fingerprinted as this may delay the processing of the transfer" [7]. See LIC 9163 for the Live Scan form.

The penalty. Section 87355(f) says a violation of § 87355(e) "shall result in a citation of a deficiency and an immediate assessment of civil penalties of one hundred dollars ($100) per violation per day for a maximum of five (5) days" [3]. Section 87355(f)(1) adds: "Subsequent violations within a twelve (12) month period will result in a civil penalty of one hundred dollars ($100) per violation per day for a maximum of thirty (30) days" [3]. HSC § 1569.17(c)(1)(B) sets penalties for a licensee's failure "to comply with paragraph (1) of subdivision (g)" [6].

Children's facilities. Item III says a Child Abuse Central Index clearance must be on file "if the transfer is to a facility serving children." The Out-of-State Disclosure section is "required for all Children's Residential Facilities" with listed exceptions [1]. The form does not say what applies to an RCFE.

Where it is kept

Where it goes. The form says: "Submit completed forms to your licensing office" [1]. CDSS says to send it to "the local CCLD office" [7]. HSC § 1569.17(g)(1) also allows the request through "the department's secure online portal" [6]. CDSS's Guardian FAQs say Guardian "allows you to transfer (connect) an in-process, cleared or exempted individual" to your agency in real time [8].

What CDSS does with it. Page 2 has a box "FOR REGIONAL OFFICE USE ONLY" with "Date of clearance transfer entry" and "Initials of person entering transfer." Below it the form prints "FILE IN NEWLY ASSOCIATED FACILITY/ORGANIZATION FILE" [1].

The home's record. Section 87355(j) says the licensee "shall maintain documentation of criminal record clearances or criminal record exemptions of employees in the individual's personnel file" [3]. CDSS's list of records an RCFE keeps, dated 4/05, names "Criminal Record Clearance or Exemption" under "Personnel Records" and no form number [10].

How long to keep it. The form gives no period [1]. Section 87412(h): "All personnel records shall be retained for at least three (3) years following termination of employment" [5]. Section 87412 does not name LIC 9182 [5].

What the record must show

For an employee who must be fingerprinted, § 87412(a)(13) requires the personnel record to hold [5]:

  • a signed statement about their criminal record history, "as required by Section 87355(d)"
  • documentation of either a criminal record clearance or a criminal record exemption, "as required by Section 87355(e)"

Section 87412(b)(3) asks the same for volunteers who must be fingerprinted [5]. HSC § 1569.17(c)(1)(A), as amended effective September 18, 2026, says: "The department shall not require the person to disclose their criminal history information prior to receipt of live scan results" [6].

Questions

Is LIC 9182 the same as LIC 9188?

No. CDSS lists LIC 9188 (1/26) as the "Criminal Record Exemption Transfer Request" [2]. Section 87355(e)(4) points to a transfer of an exemption under § 87356(r) [3].

Can one form cover more than one facility?

The form and CDSS's Transferring Clearance page disagree. The form says "Please complete one form for each facility number" [1]. The CDSS page says transfers "to more than one facility may be requested on one form" with an attached list of facility numbers [7].

Can the home file it online?

HSC § 1569.17(g)(1) allows the request on a department form "or" through the department's secure online portal [6]. CDSS's Guardian FAQs describe transfers in Guardian [8]. The statute does not name Guardian.

How long does CDSS keep a clearance on file after someone leaves?

At least two years. HSC § 1569.17(g)(2): "The State Department of Social Services shall hold criminal record clearances in its active files for a minimum of two years after an employee is no longer employed at a licensed facility in order for the criminal record clearances to be transferred under this section" [6].

Why does Title 22 list a different revision?

Section 87355(c)(1) names "LIC 9182 (Rev. 4/02)" [3]. The CDSS list shows (12/25) [2]. CDSS's Provider Information Notice (PIN) 24-10-CCLD says "individuals are strongly encouraged to use the new version of the applicable form when submitting outside of the Department's online portal" [9].

How Sevana Care keeps this record

Where does a new hire's clearance paperwork go? Each staff member's personnel file in Sevana Care has a required place for a clearance or exemption, and its upload screen says not to upload the DOJ or FBI record itself. On the Team page, Sevana Care also lists each person's credentials by type, including background check and fingerprinting (LiveScan), and each can carry an expiry date. We don't fill in the LIC 9182. Pick a staff member on the Team page in the sample home to see a personnel file.

More in Staff and background checks

  • LIC 500: The roster of staff, volunteers and other adults in the home, with duty hours
  • LIC 503: The health screening and TB result for each staff member
  • SOC 341A: The mandated reporter statement a new employee signs

Sources

  1. CDSS, LIC 9182 (12/25), Criminal Background Clearance Transfer Request (PDF)
  2. CDSS, Forms and Publications (I-L)
  3. California Code of Regulations, Title 22, § 87355, Criminal Record Clearance (Westlaw)
  4. California Code of Regulations, Title 22, § 87411, Personnel Requirements--General (Westlaw)
  5. California Code of Regulations, Title 22, § 87412, Personnel Records (Westlaw)
  6. Health and Safety Code § 1569.17 (leginfo.legislature.ca.gov)
  7. CDSS, Transferring a Clearance to a New Facility
  8. CDSS, Guardian FAQs
  9. CDSS, PIN 24-10-CCLD, Care Provider Management Branch Background Check Form Revisions (PDF)
  10. CDSS, LIC 311F (4/05), Records To Be Maintained At The Facility, Residential Care Facility For The Elderly (PDF)