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 Contact Us

Phone: (916) 552-8632

For application status requests, please include the following in your email:

  • Name of Facility or Agency
  • License or Facility/Agency # (if applicable)
  • Address
  • Facility or Provider Type
  • Date Documentation Sent
  • Contact Number​​​​​​​

Intermediate Care Facilities for the Developmentally Disabled-Continuous Nursing

Application Instructions for Change of Certification​

To request and submit changes to a licensed facility in California, complete the required application forms and submit them with all the identified supporting documents. The Centralized Applications Branch (CAB) will not process incomplete applications.

These instructions assist in preparing an ICF/DD, ICF/DD-H, ICF/DD-N, and ICF/DD-CN report of change application packet for a Change of Certification (CHOC).​

Please read each required application form carefully and:

  • Provide all requested supporting documents
  • Retain a copy of the completed application forms and supporting documents – CAB may contact the applicant and will refer to the information provided​​​

Review Process

CAB receives an application packet and assigns an application ID number in the Electronic Licensing Management System. A CAB analyst reviews the application packet to validate receipt of all the required forms and supporting documents. Application packets missing forms and/or supporting documents are incomplete and may result in a delay in processing. ​

Submission of Applications​

Submit completed application packets to:

          California Department of Public Health
          Licensing and Certification Program
          Centralized Applications Branch
          P.O. Box 997377, MS 3207
          Sacramento, CA 95899-7377

If you have any questions, please contact CAB at (916) 552-8632 or by e-mail at


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