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This version of the form is not currently in use and is provided for reference only. Download this version of
Form LIC9141
for the current year.
Form LIC9141 Vendor Application / Renewal - Administrator Certification Program - California
What Is Form LIC9141?
This is a legal form that was released by the California Department of Social Services - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is the LIC9141 form?
A: The LIC9141 form is the Vendor Application/Renewal for the Administrator Certification Program in California.
Q: What is the Administrator Certification Program?
A: The Administrator Certification Program is a program in California that certifies administrators who work in residential care facilities for the elderly.
Q: Who needs to submit the LIC9141 form?
A: Vendors who wish to participate in the Administrator Certification Program in California need to submit the LIC9141 form.
Q: What information is required on the LIC9141 form?
A: The LIC9141 form requires information such as the vendor's name, contact information, and details about their qualifications and experience.
Q: Is the LIC9141 form for initial application or renewal?
A: The LIC9141 form can be used for both initial application and renewal of participation in the Administrator Certification Program.
Form Details:
- Released on June 1, 2016;
- The latest edition provided by the California Department of Social Services;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form LIC9141 by clicking the link below or browse more documents and templates provided by the California Department of Social Services.
Download Form LIC9141 Vendor Application / Renewal - Administrator Certification Program - California
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