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Form LIC421D(ASC) Civil Penalty Assessment " Death / Serious Bodily Injury / Physical Abuse (Asc) - California
What Is Form LIC421D(ASC)?
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 Form LIC421D(ASC)?
A: Form LIC421D(ASC) is a Civil Penalty Assessment form related to death, serious bodily injury, or physical abuse in California.
Q: What is the purpose of Form LIC421D(ASC)?
A: The purpose of Form LIC421D(ASC) is to assess civil penalties for cases involving death, serious bodily injury, or physical abuse in California.
Q: Who is required to file Form LIC421D(ASC)?
A: This form is typically filed by individuals or entities responsible for a facility or program that is licensed or certified in California, and is involved in a case of death, serious bodily injury, or physical abuse.
Q: What happens after Form LIC421D(ASC) is filed?
A: After the form is filed, an investigation may be conducted, and civil penalties may be assessed based on the findings.
Form Details:
- Released on June 1, 2017;
- 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 LIC421D(ASC) by clicking the link below or browse more documents and templates provided by the California Department of Social Services.
Download Form LIC421D(ASC) Civil Penalty Assessment " Death / Serious Bodily Injury / Physical Abuse (Asc) - California
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