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EDMUND G. BROWN JR.
Governor

State of California—Health and Human Services Agency
California Department of Public Health


AFL 11-06
January 6, 2011


TO:
Home Health Agencies

SUBJECT:
Fingerprint Clearance Requirements for Owners, Administrators, and Administrator’s Designee


The purpose of this All Facilities Letter is to serve as a reminder of the criminal record clearance requirements for home health agencies licensed by the department. Pursuant to Health and Safety Code Section 1728.1(a)(2)(A) a criminal record clearance is required for
the following individuals:

  • The owner or owners of a home health agency if the owners are individuals;
  • If the owner of a home health agency is a corporation, partnership or association, any
    person having a ten (10) percent or greater interest in that corporation, partnership or
    association and;
  • The administrator and administrator’s designee of a home health agency.

The individuals identified above are required to submit a Request for Live Scan Service: BCII 8016 form. For your convenience, a link to the BCII 8016 and a sample form is provided. The "sample form" provides instructions to assist you in correctly entering the required information. Once the form is completed, the Request for a Live Scan Service: BCII 8016 form should be taken to a live scan vendor.

Please note the live scan vendor will complete the Transaction Section (gray area) of the Live Scan Service: BCII 8016 form.

The following link to the California Department of Justice website may assist you in locating a live scan vendor.

Live Scan Locations

Once the live scan process is complete, please submit the CDPH 325 Criminal Record Clearance Submission listing the owners, administrators, and proof of live scan to the Centralized Applications Unit. The CDPH 325 form can be found using the following link:

All individuals identified above who have not already completed the criminal record clearance process should mail the CDPH 325 on or before March 31, 2011 to:

Department of Public Health
Licensing and Certification Program
Centralized Applications Unit
P. O. Box 997413, MS 3402
Sacramento, CA 95899-7413
Attention: Imelda Ruiz

Failure to comply with the above may result in a delay or denial of license renewal.

If you have any questions, contact Elena Marquez, Chief of the Centralized Applications Unit at (916) 552-8756.

 

Sincerely,

Original Signed by Pamela Dickfoss

Pamela Dickfoss
Acting Deputy Director

 

 

​Reference

1 https://oag.ca.gov/sites/all/files/agweb/pdfs/fingerprints/forms/BCIA_8016.pdf 

https://www.cdph.ca.gov/CDPH%20Document%20Library/ControlledForms/cdph325.pdf

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