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Applications for Licensing and/or Certification of an Intermediate Care Facility for the Developmentally Disabled

The following forms and documents are required for licensure and/or certification. 

In addition to the forms below, you are required to submit additional documents for a change of ownership plus information regarding your Program Plan, and Consultants. These documents must be submitted with your completed application. The required information needed and instructions are listed in the checklist contained in the Intermediate Care Facility For the Developmentally Disabled Application Request Letter and Instructional Checklist letter.Opens a new browser window

Intermediate Care Facility/Developmentally Disabled,
Intermediate Care Facility/Developmentally Disabled-Habilitative, &
Intermediate Care Facility/Developmentally Disabled-Nursing

Required Forms to be Licensed:

Required Forms to be Certified with Medicaid/Medi-Cal:

Last modified on: 6/7/2012 12:27 PM