GO-Biz Application Forms and Fee Finder
Name of Permit, License, or Registration
Brief Description of Purpose
Application
Fee Information
Keywords
Seismic Mitigation Program Eligibility Forms
Facility Hardship Request Sheet
http://www.documents.dgs.ca.gov/opsc/Forms/Worksheets/FacHS_WS.pdf
Free
SAB 50-04 Application for Funding
http://www.documents.dgs.ca.gov/opsc/Forms/SAB_50-04.pdf
Free
SAB 50-05 Fund Release Authorization
http://www.documents.dgs.ca.gov/opsc/Forms/SAB_50-05.pdf
Free
SAB 50-06 Expenditure Report
http://www.documents.dgs.ca.gov/opsc/Forms/SAB_50-06.pdf
Free
State Relocatable Classroom Program (SRCP) Forms
SAB 25-46 Application to Purchase State Relocatable 
Classroom(s)
http://www.documents.dgs.ca.gov/opsc/Forms/SAB_25-46.pdf
Free
SAB 25-46A Application to Purchase State Relocatable 
Classroom(s) - Attachment A
http://www.documents.dgs.ca.gov/opsc/Forms/SAB_25-46A.pdf
Free
SAB 25-46B SCRP Classroom Evaluation Checklist
http://www.documents.dgs.ca.gov/opsc/Forms/SAB_25-46B.pdf
Free
Unused Site Program Forms
SAB 424 Modification of Unused Site Status
http://www.documents.dgs.ca.gov/opsc/Forms/SAB_424.pdf
Free
Other Forms
SAB 189 School District Appeal Request
http://www.documents.dgs.ca.gov/opsc/Forms/SAB_189.pdf
SAB 406 Exemption Request
http://www.documents.dgs.ca.gov/opsc/Forms/SAB_406.pdf
SAB 598 Public Access Information Request
http://www.documents.dgs.ca.gov/opsc/Forms/SAB_598.pdf
HORSE RACING BOARD, CALIFORNIA
General Application for Horse Racing Board Licenses
Universal form for: Officer, Director, Partner, 5% Stock 
Holder of Racing Association, Simulcast Service Supplier, 
Totalizator Company, Horse Owner, Trainer, Asst Trainer, 
Jockey, Agent, Veterinarian, Racing Official, Valet, Pony 
Rider, Horseshoer, Sable Agent, Security, Clerical
http://www.chrb.ca.gov/forms/chrb_4_application_for_license.pdf
http://www.chrb.ca.gov/occupational_license_fees.asp
Renewal or Replacement License
http://www.chrb.ca.gov/forms/chrb_6_application_for_renewal_or_replacement_license.pdf
Fee printed on form
Application for Registration of Authorized Agent
http://www.chrb.ca.gov/forms/chrb_10_application_for_registration_of_authorized_agent.pdf
Not specified
Application to Register or Review a Stable Name
http://www.chrb.ca.gov/forms/chrb_12_application_to_register_or_renew_a_stable_name.pdf
Fee printed on form
Application to Register Multiple Ownership
http://www.chrb.ca.gov/forms/chrb_13_application_to_register_multiple_ownership.pdf
Fee printed on form
Renewal of Owner's License
http://www.chrb.ca.gov/forms/chrb_31_application_for_renewal_of_owners_license.pdf
Fee printed on form
Supplement Application for License as Trainer
http://www.chrb.ca.gov/forms/chrb_41_supplement_application_for_license_as_trainer.pdf
Not specified
Supplement Application for License as Owner
http://www.chrb.ca.gov/forms/chrb_41_supplement_application_for_license_as_trainer.pdf
Not specified
Guardian's Statement
http://www.chrb.ca.gov/forms/chrb_44_guardians_statement.pdf
Not specified
Agreement for the Employment of a Minor
http://www.chrb.ca.gov/forms/chrb_48_agreement_for_the_employment_of_a_minor.pdf
Not specified
Request to Release Evidence
http://www.chrb.ca.gov/forms/chrb_56_Request_To_Release_Evidence.pdf
Not specified
Notice of Cancellation of Authorized Agent 
http://www.chrb.ca.gov/forms/chrb_77_notice_of_cancellation_of_authorized_agent.pdf
Not specified
Bill of Sale
http://www.chrb.ca.gov/forms/chrb_101_bill_of_sale.pdf
Not specified
Notification of Exclusion
http://www.chrb.ca.gov/forms/chrb_134_notification_of_exclusion.doc
Not specified
Change of Address
http://www.chrb.ca.gov/forms/notice_of_change_of_address.pdf
Not specified
HOUSING AND COMMUNITY DEVELOPMENT, 
DEPARTMENT OF
Enter name of permit, license, or registration
http://www.hcd.ca.gov/codes/ol/2006_OL_FEE_INCREASE_INFO_SHEET.pdf
horse, racing, stallion, steed, track, owner, trainer, jockey, 
pony, stable, horseshoer, 
housing, commercial coach, employee housing, factory 
built housing, manufactured home, mobilehome, 
commercial coach, permits, food truck
Last Updated 4/24/2014
How to convert pdf to ppt using - software SDK dll:C# Create PDF from PowerPoint Library to convert pptx, ppt to PDF in C#.net, ASP.NET MVC, WinForms, WPF
Online C# Tutorial for Creating PDF from Microsoft PowerPoint Presentation
www.rasteredge.com
How to convert pdf to ppt using - software SDK dll:VB.NET Create PDF from PowerPoint Library to convert pptx, ppt to PDF in vb.net, ASP.NET MVC, WinForms, WPF
VB.NET Tutorial for Export PDF file from Microsoft Office PowerPoint
www.rasteredge.com
GO-Biz Application Forms and Fee Finder
Name of Permit, License, or Registration
Brief Description of Purpose
Application
Fee Information
Keywords
Factory-Built Housing
General Info
http://www.hcd.ca.gov/codes/fbh
Enter name of permit, license, or registration
INDUSTRIAL RELATIONS, DEPARTMENT OF
Enter name of permit, license, or registration
INSURANCE, DEPARTMENT OF
Enter name of permit, license, or registration
JUSTICE, DEPARTMENT OF
Check Cashing Permits
Every owner of a check-cashing business in California is 
required by law to obtain a permit from the Attorney 
General's Office
http://oag.ca.gov/casher/forms
http://oag.ca.gov/casher/faqs
check cashing, mobile check cashing, money service, 
financial,
Charities
Persons holding property for charitable purposes, 
including nonprofit public benefit corporations, must 
register and file financial reports with the Attorney 
General's Registry of Charitable Trusts
http://ag.ca.gov/charities/forms.php
Fee printed on form
charity, nonprofit, public benefit, charitable trusts,
Credit Service Organizations
Any person who sells or provides services to improve a 
consumer's credit record, history or rating, which may 
include obtaining a loan or extension of credit for the 
consumer, is required to register with the Attorney 
General's Office. Excluded are banks and financial 
institutions otherwise regulated by government
http://ag.ca.gov/consumers/general/csoform.php
http://oag.ca.gov/consumers/general/csoform
consumer credit, credit, credit record, credit history, credit 
rating, loan, extension of credit
Fingerprint Roller Certification
California law requires any individual who rolls 
fingerprints manually or electronically for licensure, 
certification and/or employment purposes to be certified 
by the state Department of Justice
http://ag.ca.gov/fingerprints/finger_cert.php
http://oag.ca.gov/fingerprints/finger_cert
fingerprint, fingerprint roller, 
Foreclosure Consultant Registration
By July 1, 2009, any person or company who performs or 
promises or offers to perform the services of a 
foreclosure consultant must register with the Attorney 
General’s Office, post a $100,000 bond and receive a 
ertificate of Registration from the AG’s Office or go out 
of business
http://ag.ca.gov/consumers/general/foreclosure_reg.php
http://oag.ca.gov/consumers/general/foreclosure_reg
foreclosure, foreclosure consultant, home, bankruptcy, sale
Gaming License
Applications and/or documents required for gaming 
activities in California used by the Attorney General's 
Division of Gambling Control and the California Gambling 
Control Commission
http://ag.ca.gov/gambling/forms.php
http://oag.ca.gov/gambling/forms/forms_fee_calculation
gambling, casino, game, tables, bingo, players, antique 
collector, fundraisers, tribal, cardrooms
housing, commercial coach, employee housing, factory 
built housing, manufactured home, mobilehome, 
commercial coach, permits, food truck
Last Updated 4/24/2014
software SDK dll:Online Convert PowerPoint to PDF file. Best free online export
Download Free Trial. Convert a PPTX/PPT File to PDF. Easy converting! We try to make it as easy as possible to convert your PPTX/PPT files to PDF.
www.rasteredge.com
software SDK dll:How to C#: Convert PDF, Excel, PPT to Word
From MS-PPT and MS-PPTX to Word. RootPath + "\\" Output.docx"; // Load a PDF document PDFDocument doc = new PDFDocument(inputFilePath); // Convert it to Word
www.rasteredge.com
GO-Biz Application Forms and Fee Finder
Name of Permit, License, or Registration
Brief Description of Purpose
Application
Fee Information
Keywords
International Student Exchange Placement Organizations
Anyone who regularly arranges the placement of foreign 
exchange students in California elementary, junior high 
and high schools must register with the Attorney 
General's Office prior to making the placement
http://ag.ca.gov/exchangestudents/register.php
Free
International, student exchange, foreign, placement, 
school, high school, middle school, junior high, elementary 
school
Proposition 65 Enforcement Reporting
State law requires any person suing "in the public 
interest" to enforce Proposition 65, the Safe Drinking and 
Toxic Enforcement Act of 1986, to notify the Attorney 
General of the lawsuit and outcome of the case
http://ag.ca.gov/prop65/index.php
Free
proposition 65, safe drinking water, toxic, 
Raffle Registration
Charities and certain other private nonprofit 
organizations must register with the Attorney General's 
Registry of Charitable Trusts prior to holding fund-raising 
raffles
http://ag.ca.gov/charities/raffles.php#forms
Free
Raffle, charity, fundraising
Security Prescription Printers
Printers seeking to produce tamper-resistant prescription 
forms for purchase by prescribers of controlled drugs in 
California must apply with the Department of Justice to 
be placed on the state's "approved printers" list.
http://ag.ca.gov/bne/prescriptions.php
http://oag.ca.gov/security-printers
security prescription printer, tamper, prescription, 
controlled drugs, 
Seller-Assisted Marketing Plans
Persons selling business opportunities for initial 
payments of $500 to $50,000 must register with the 
Attorney General's Office prior to advertising or sales, 
unless otherwise licensed or regulated
http://ag.ca.gov/consumers/general/samp.php
http://oag.ca.gov/sites/all/files/agweb/pdfs/consumers/samp_letter.pdf?
marketing, business opportunity, advertising, sales
Seller of Travel
All sellers of travel doing business in California must 
register with the Attorney General's Office and display 
the registration number in their advertising
http://ag.ca.gov/travel/forms.php
Fee printed on form
travel, seller, advertising
Telephonic Sellers
A seller soliciting business by telephone in California is 
required to register with the state
http://ag.ca.gov/consumers/general/telreg.php
http://oag.ca.gov/sites/all/files/agweb/pdfs/consumers/tele_instructions.pdf?
telephone, phone, solicitation, seller, telemarketing
Tobacco Product Registration
Tobacco manufacturers are required by law to enter 
brands into the California Tobacco Directory prior to sale 
in the state
http://ag.ca.gov/tobacco/directory.php
http://ag.ca.gov/tobacco/directory.php
tobacco, smoke, cigarettes, nicotine, chewing tobacco, 
cigars, creamy snuff, dipping tobacco, dissolvable tobacco, 
dokha, gutka, kizami, mu'assel, pipe tobacco, snuff, snus, 
tobacco gum, tobacco water, topical tobacco paste
LOTTERY COMMISSION, CALIFORNIA STATE
Lottery Retailer Program
http://www.calottery.com/retailer
Request a Retail Evaluation
Lottery retailers may request an evaluation from 
CalLottery to ensure their facility is suitable for lottery 
sales.
http://www.calottery.com/retailer/request-evaluation
Lottery District Offices
http://www.calottery.com/retailer/retailer-contacts
MOTOR VEHICLES, DEPARTMENT OF
Occupational Licenses
General Information
http://www.dmv.ca.gov/vehindustry/ol/olbranch_top.htm
See individual licenses for fee information.
All-Terrain Vehicle Safety Training
All Terrain Vehicle Safety Training Organizations
http://www.dmv.ca.gov/vehindustry/ol/atv.htm
http://www.dmv.ca.gov/vehindustry/ol/atv.htm
Vehicle Dealers
New, Used, and Wholesale-Only Dealers
http://www.dmv.ca.gov/vehindustry/ol/dealer.htm
http://www.dmv.ca.gov/vehindustry/ol/dealer.htm
Vehicle Dismantlers
http://www.dmv.ca.gov/vehindustry/ol/dismantler.htm
http://www.dmv.ca.gov/vehindustry/ol/dismantler.htm
Vehicle Distributors
http://www.dmv.ca.gov/vehindustry/ol/distributor.htm
http://www.dmv.ca.gov/vehindustry/ol/distributor.htm
Driving Schools
General Information
http://www.dmv.ca.gov/vehindustry/ol/drschool.htm
N/A
Driving School Owner License
http://www.dmv.ca.gov/vehindustry/ol/dsowner.htm
http://www.dmv.ca.gov/vehindustry/ol/dsowner.htm
Driving School Operator License
http://www.dmv.ca.gov/vehindustry/ol/drschopr.htm
http://www.dmv.ca.gov/vehindustry/ol/drschopr.htm
Driving School Instructor License
http://www.dmv.ca.gov/vehindustry/ol/drschinst.htm
http://www.dmv.ca.gov/vehindustry/ol/drschinst.htm
Independent Driving Instructor License
http://www.dmv.ca.gov/vehindustry/ol/indinstr.htm
http://www.dmv.ca.gov/vehindustry/ol/indinstr.htm
Employer Testing Program
For commercial drivers
http://www.dmv.ca.gov/vehindustry/etp/etpinfo.htm
http://www.dmv.ca.gov/vehindustry/etp/etpinfo.htm
Breath Alcohol Ignition Interlock Device Self-
Certification
http://www.dmv.ca.gov/vehindustry/ol/forms/ignitioninterlockdevicelist.htm
Varies by device selected
Lessor-Retailer
http://www.dmv.ca.gov/vehindustry/ol/lessor.htm
http://www.dmv.ca.gov/vehindustry/ol/lessor.htm
Vehicle Manufacturer License
http://www.dmv.ca.gov/vehindustry/ol/manufacturer.htm
http://www.dmv.ca.gov/vehindustry/ol/manufacturer.htm
Mature Driver Improvement Courses
http://www.dmv.ca.gov/vehindustry/ol/mature_drvr.htm
http://www.dmv.ca.gov/vehindustry/ol/mature_drvr.htm
Registration Service License
http://www.dmv.ca.gov/vehindustry/ol/regservice.htm
http://www.dmv.ca.gov/vehindustry/ol/regservice.htm
lottery, gambling, winning numbers, lotto, scratchers, 
instant win, ticket
Last Updated 4/24/2014
software SDK dll:C# TIFF: Learn to Convert MS Word, Excel, and PPT to TIFF Image
using RasterEdge.Imaging.PowerPoint; Load your PPT (.pptx) document null == doc) throw new Exception("Fail to load PowerPoint Document"); // Convert PPT to Tiff
www.rasteredge.com
software SDK dll:C# PDF Convert: How to Convert MS PPT to Adobe PDF Document
high performance PDF conversion from Microsoft PowerPoint (.ppt and .pptx). FILE_TYPE_UNSUPPORT: Console.WriteLine("Fail: can not convert to PDF, file type
www.rasteredge.com
GO-Biz Application Forms and Fee Finder
Name of Permit, License, or Registration
Brief Description of Purpose
Application
Fee Information
Keywords
Remanufacturer License
A “vehicle remanufacturer” is any person who produces a 
vehicle consisting of used or reconditioned parts subject 
to registration under the California Vehicle Code Section 
507.8.
http://www.dmv.ca.gov/vehindustry/ol/remanufacturer.htm
http://www.dmv.ca.gov/vehindustry/ol/remanufacturer.htm
Representative License
A “representative” is any person regularly employed by a 
manufacturer or distributor for the purpose of 
negotiating or promoting the sale of the manufacturer’s 
or distributor’s vehicles to their franchisees or for 
regularly supervising or contacting franchisees or 
prospective franchisees in this state for any purpose.
http://www.dmv.ca.gov/vehindustry/ol/representative.htm
http://www.dmv.ca.gov/vehindustry/ol/representative.htm
Vehicle Salesperson License
http://www.dmv.ca.gov/vehindustry/ol/salesperson.htm
http://www.dmv.ca.gov/vehindustry/ol/salesperson.htm
Traffic Violator School Program
General Information
http://www.dmv.ca.gov/vehindustry/ol/tvschool.htm
N/A
Traffic Violator School Owner License
http://www.dmv.ca.gov/vehindustry/ol/tvschowner.htm
http://www.dmv.ca.gov/vehindustry/ol/tvschowner.htm
Traffic Violator School Operator License
http://www.dmv.ca.gov/vehindustry/ol/tvsoperator.htm
http://www.dmv.ca.gov/vehindustry/ol/tvsoperator.htm
Traffic Violator School Instructor License
http://www.dmv.ca.gov/vehindustry/ol/tvsinstructor.htm
http://www.dmv.ca.gov/vehindustry/ol/tvsinstructor.htm
Vehicle Transporter License
http://www.dmv.ca.gov/vehindustry/ol/transporter.htm
http://www.dmv.ca.gov/vehindustry/ol/transporter.htm
Vehicle Verifier License
A "vehicle verifier" is a person not expressly excluded by 
California Vehicle Code (CVC) Section 675.6 who inspects, 
records, documents, and submits to the department, or 
its authorized representative, such proof of vehicle 
identification as may be required by the department for 
the purpose of registering or transferring the ownership 
of vehicles.
http://www.dmv.ca.gov/vehindustry/ol/verfier.htm
http://www.dmv.ca.gov/vehindustry/ol/verfier.htm
Vessel Agent
A "vessel agent" is any individual who offers to sell or 
register watercraft capable of being used as a means of 
trasnporation on the water, except as listed in California 
Vehicle Code (CVC) Section 9840 (1)-(3).
http://www.dmv.ca.gov/vehindustry/ol/vessel_agent.htm
http://www.dmv.ca.gov/vehindustry/ol/vessel_agent.htm
PARKS AND RECREATION, DEPARTMENT OF
Park Passes
http://store.parks.ca.gov/park-passes/
http://www.parks.ca.gov/?page_id=1047
Disabled Discount Pass Application
Lifetime Pass
http://www.parks.ca.gov/pages/737/files/dpr818a.pdf
http://www.parks.ca.gov/?page_id=1047
Distinguished Veteran Pass Application
Lifetime Pass
http://www.parks.ca.gov/pages/737/files/dpr619.pdf
Free
Golden Bear Pass
http://www.parks.ca.gov/pages/737/files/DPR578.pdf
http://www.parks.ca.gov/?page_id=1047
Limited Use Golden Bear Pass
http://www.parks.ca.gov/pages/737/files/dpr847a_2013.p
df
http://www.parks.ca.gov/?page_id=1048
Reservations
http://www.parks.ca.gov/?page_id=1023
http://www.parks.ca.gov/pages/737/files/Current_web_camping.pdf
PILOT COMMISSIONERS, BOARD OF
Pilot trainee application
Application for San Francisco Pilot Trainee Program
http://www.bopc.ca.gov/res/docs/pdfs/Application.pdf
Free
National Maritime Credentialing
http://www.uscg.mil/nmc/credentials/default.asp
Free
PUBLIC HEALTH, DEPARTMENT OF
All DPH Forms
http://www.cdph.ca.gov/certlic/Pages/default.aspx
Genetic Counselor License
Genetic Counselor Licensure is pursuant to Health and 
Safety Code Section 124981 and 124982.  Licensure 
provides title protection, and the regulations define the 
qualifications for obtaining a Genetic Counselor License 
or Temporary Genetic Counselor License, and the 
continuing education requirements for renewing a 
Genetic Counselor license.  The regulations define the 
denial and revocation of licenses, as well as set the 
license fees.
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/cdph4486.pdf
http://cdph.ca.gov/pubsforms/forms/CtrldForms/cdph4487.pdf
pilot, maritime, ships, water, boat, waterway, bay, 
driving, vehicle, traffic, motor, transportation, vessel, auto, 
car, boat
parks, recreation, pass, golden, bear, green space, 
Last Updated 4/24/2014
software SDK dll:VB.NET PowerPoint: Process & Manipulate PPT (.pptx) Slide(s)
the order of current PowerPoint slides using VB.NET control add-on can do PPT creating, loading powerful & profession imaging controls, PDF document, image to
www.rasteredge.com
software SDK dll:VB.NET PowerPoint: Convert & Render PPT into PDF Document
VB.NET PowerPoint - Render PPT to PDF in VB.NET. How to Convert PowerPoint Slide to PDF Using VB.NET Code in .NET. Visual C#. VB.NET. Home > .NET Imaging SDK >
www.rasteredge.com
GO-Biz Application Forms and Fee Finder
Name of Permit, License, or Registration
Brief Description of Purpose
Application
Fee Information
Keywords
Genetic Counselor Licensure Continuing Education 
Declaration
This report should be submitted with your application for 
renewal of your Genetic Counselor License.
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/cdph4488.pdf
Free
LiveScan Application Form for Genetic Counseling
Complete Live Scan Service process: If you are applying 
for the Genetic Counselor License or Temporary Genetic 
Counselor License, a background check is required. A 
Request for Live Scan Service form can be downloaded 
from the GDSP website. Please note that some fields 
have been pre-filled with mandatory information that is 
not editable. You will need to complete the remainder of 
the form and make two copies
http://www.cdph.ca.gov/programs/GDSP/Documents/BCII_8016%20New%20Live%20Scan%20form.pdf
http://ag.ca.gov/fingerprints/index.php
Health Facility License
To obtain licensure of a health facility
http://www.cdph.ca.gov/pubsforms/forms/Pages/HealthFa
cilities.aspx
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertAnn
ualReport2013.pdf
Adult Day Health Center
Licensure & Certification Application
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/hs2
00.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Application Individual Information
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/hs2
15a.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Administrative Organization
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/hs3
09.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Transmittal Application for Criminal Background 
Investigation
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/cdp
h322.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Transfer Agreement
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/hs6
02.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Request for Live Scan Service
http://ag.ca.gov/fingerprints/forms/BCIA_8016.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Administrator and Program Director Information
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/cda
278.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Local Fire Inspection Authority Information
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/cda
282.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Affiliate Primary Care Clinic
Affiliate Primary Care Clinic Application Request Letter 
and Instructional Checklist
http://www.cdph.ca.gov/pubsforms/forms/Documents/LN
C-APCC-AppRequestLtrChecklist2012.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Licensure & Certification Application for an Affiliate 
Primary Care Clinic
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/cdp
h611.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Certification Form for Clinics and Freestanding Outpatient 
Clinic Services of a Hospital
To be used in lieu of a letter from a licensed architect
http://www.cdph.ca.gov/pubsforms/forms/Documents/Cli
nicsCertificationForm.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Applicant Individual Information
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/hs2
15a.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Transfer Agreement Between
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/hs6
02.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Fire Safety Inspection Request
http://www.documents.dgs.ca.gov/osp/pdf/std850.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Civil Rights Compliance Review
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/dhc
s1051.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Required Forms to be Certified with Medicaid/Medi-Cal:
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Application for Medi-Cal Certification as a Primary 
Care Clinic Provider
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/hs2
69.pdf
Free
Notice - Effective Date of Provider Agreement
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/hs3
28.pdf
Free
public, health, genetic, 
Last Updated 4/24/2014
software SDK dll:VB.NET PowerPoint: Use PowerPoint SDK to Create, Load and Save PPT
This page mainly focuses on how users can get started by using this perfect VB.NET PPT document control with document pre-processing functions, including
www.rasteredge.com
software SDK dll:VB.NET PowerPoint: Extract & Collect PPT Slide(s) Using VB Sample
NET PPT slide extracting demo code using RasterEdge VB NET PPT slide adding/removing, PPT merging/splitting & profession imaging controls, PDF document, image
www.rasteredge.com
GO-Biz Application Forms and Fee Finder
Name of Permit, License, or Registration
Brief Description of Purpose
Application
Fee Information
Keywords
Medi-Cal Provider Agreement
http://files.medi-cal.ca.gov/pubsdoco/Publications/masters-
other/provappsenroll/21enrollment_DHCS9098.pdf
Free
Chronic Dialysis Clinic (End Stage Renal Dialysis)
Licensure & Certififcation Application
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/hs2
00.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Certification Form for Clinics and Freestanding Outpatient 
Clinic Services of a Hospital
http://www.cdph.ca.gov/pubsforms/forms/Documents/Cli
nicsCertificationForm.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Applicant Individual Information
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/hs2
15a.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Administrative Organization
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/hs3
09.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Transfer Agreement Between
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/hs6
02.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Civil Rights Compliance Review
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/dhc
s1051.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Required Forms to be Certified with Medicaid/Medi-Cal:
Free
Notice - Effective Date of Provider Agreement
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/hs3
28.pdf
Free
Medi-Cal Provider Agreement
http://files.medi-cal.ca.gov/pubsdoco/Publications/masters-
other/provappsenroll/21enrollment_DHCS9098.pdf
Free
Required Forms to be Certified with Medicare:
Free
Notice - Effective Date of Provider Agreement
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/hs3
28.pdf
Free
Medicare General Enrollment Health Care 
Provider/Supplier Application
http://www.cms.hhs.gov/cmsforms/downloads/cms855a.p
df
Free
End-Stage Renal Disease Application/Notification and 
Survey and Certification Report
http://www.cms.gov/Medicare/Provider-Enrollment-and-
Certification/GuidanceforLawsAndRegulations/Downloads/
cms3427esrdapplication.pdf
Free
Congregate Living Health Facility (CLHF)
Licensure & Certification Application
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/hs2
00.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Application Individual Information
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/hs2
15a.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Administrative Organization
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/hs3
09.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Affidavit Regarding Patient Money
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/hs4
00.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Surety Bond Verification
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/hs4
02.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Transfer Agreement Between
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/hs6
02.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Fire Safety Inspection Request
http://www.documents.dgs.ca.gov/osp/pdf/std850.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
General Acute Care Hospital
Licensure & Certification Application
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/hs2
00.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Application Individual Information
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/hs2
15a.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Administrative Organization
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/hs3
09.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Affidavit Regarding Patient Money
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/hs4
00.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Surety Bond Verification
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/hs4
02.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Bed or Service Request
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/cdp
h609.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Last Updated 4/24/2014
GO-Biz Application Forms and Fee Finder
Name of Permit, License, or Registration
Brief Description of Purpose
Application
Fee Information
Keywords
Application for Cardiovascular Surgery Service
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/cdp
h241.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Application for Chronic dialysis Service
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/cdp
h242.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Application for Dental Service
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/cdp
h243.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Application for Nuclear Medicine Service
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/cdp
h245.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Application for Outpatient Service
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/cdp
h246.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Application for pediatric Service
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/cdp
h247.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Application for Perinatal Unit
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/cdp
h248.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Application for Podiatric Service
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/cdp
h249.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Application for Psychiatric Unit
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/cdp
h250.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Application for Radiation Therapy Service
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/cdp
h251.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Application for Renal Transplant Center
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/cdp
h252.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Application for Respiratory Care Service
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/cdp
h253.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Application for Social Service
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/cdp
h255.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Application for Standby Emergency Medical Service, 
Physician on Call
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/cdp
h256.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Application for Basic Emergency medical Service, 
Physician on Duty
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/cdp
h257.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Application for Comprehensive Emergency medical 
Service
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/cdp
h258.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Application for Rehabilitation Center
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/cdp
h259.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Application for Occupational Therapy Service
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/cdp
h260.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Application for Physical Therapy Service
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/cdp
h261.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Application for Speech Pathology and/or Audiology 
Service
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/cdp
h262.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Application for Acute Respiratory Care Service
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/cdp
h263.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Application for Burn Center
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/cdp
h264.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Application for Coronary Care Service
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/cdp
h265.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Application for Intensive Care Newborn Nursery Service
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/cdp
h266.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Application for Intensive Care Services
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/cdp
h267.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Application for Supplemental Services Approval
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/cdp
h268.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Client Accommodation Analysis
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/cdp
h709.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Fire Safety Inspection Request
http://www.documents.dgs.ca.gov/osp/pdf/std850.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Civil Rights Compliance Review
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/dhc
s1051.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Required Forms to be Certified with Medicaid/Medi-Cal:
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Last Updated 4/24/2014
GO-Biz Application Forms and Fee Finder
Name of Permit, License, or Registration
Brief Description of Purpose
Application
Fee Information
Keywords
Notice - Effective Date of Provider Agreement
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/hs3
28.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Medi-Cal Provider Agreement
http://files.medi-cal.ca.gov/pubsdoco/Publications/masters-
other/provappsenroll/21enrollment_DHCS9098.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Required Forms to be Certified with Medicare:
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Notice - Effective Date of Provider Agreement
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/hs3
28.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Medicare Enrollment Application
http://www.cms.hhs.gov/cmsforms/downloads/cms855a.p
df
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Health Insurance benefit Agreement
http://www.cms.hhs.gov/cmsforms/downloads/cms1561.p
df
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Civil Rights Information Request for Medicare 
Certification
http://www.hhs.gov/ocr/civilrights/clearance/pregrantchec
klist.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Assurance of Compliance 
http://www.hhs.gov/ocr/civilrights/clearance/hhs690.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Required Forms for Adding a Hospital Outpatient Clinic
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Licensure & Certification Application
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/hs2
00.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Fire Safety Inspection Request
http://www.documents.dgs.ca.gov/osp/pdf/std850.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Application for Outpatient Service
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/cdp
h246.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Application for Supplemental Services Approval
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/cdp
h268.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Bed or Service Request
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/cdp
h609.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Required Forms for a Hospital Outpatient (Non-Urbanized 
Area) Rural Health Clinic to be Certified with Medi-Cal
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Licensure & Certification Application
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/hs2
00.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Notice - Effective Date of Provider Agreement
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/hs3
28.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Medically Underserved or Health Professional 
Shortage Areas
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/hs6
10.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Fire Safety Inspection Request
http://www.documents.dgs.ca.gov/osp/pdf/std850.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Request to Establish Eligibility
http://www.cms.gov/cmsforms/downloads/CMS29.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Medi-Cal Provider Agreement
http://files.medi-
cal.ca.gov/pubsdoco/provappsenroll/21enrollment_DHCS9
098.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Required Forms for a Hospital Outpatient (Non-Urbanized 
Area) Rural Health Clinic to be Certified with Medi-Care
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Licensure & Certification Application
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/hs2
00.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Notice - Effective Date of Provider Agreement
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/hs3
28.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Medically Underserved or Health Professional 
Shortage Areas
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/hs6
10.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Fire Safety Inspection Request
http://www.documents.dgs.ca.gov/osp/pdf/std850.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Request to Establish Eligibility
http://www.cms.gov/cmsforms/downloads/CMS29.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Medicare General Enrollment Health Care 
Provider/Supplier Application
http://www.cms.hhs.gov/cmsforms/downloads/cms855a.p
df
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Last Updated 4/24/2014
GO-Biz Application Forms and Fee Finder
Name of Permit, License, or Registration
Brief Description of Purpose
Application
Fee Information
Keywords
Health Insurance benefit Agreement
http://cms.gov/cmsforms/downloads/cms1561a.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Assurance of Compliance 
http://www.hhs.gov/ocr/civilrights/clearance/hhs690.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Home Health Agency
Required Forms to be Licensed:
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Licensure & Certification Application
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/hs2
00.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Applicant Individual Information
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/hs2
15a.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Administrative Organization
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/hs3
09.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Transmittal Application for Criminal Background 
Investigation
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/cdp
h322.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Criminal Record Clearance Submissions
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/cdp
h325.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Request for Live Scan Service
http://ag.ca.gov/fingerprints/forms/BCIA_8016.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Home Health Agency Survey and Deficiencies Repor
http://www.cms.hhs.gov/cmsforms/downloads/cms1572a.
pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Required Forms to be Certified with Medicaid/Medi-Cal:
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Notice - Effective Date of Provider Agreement
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/hs3
28.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Medi-Cal Provider Agreement
http://files.medi-cal.ca.gov/pubsdoco/Publications/masters-
other/provappsenroll/21enrollment_DHCS9098.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Home Health Agency Survey and Deficiencies Repor
http://www.cms.hhs.gov/cmsforms/downloads/cms1572a.
pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Required forms to be Certified with Medicare:
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Notice - Effective Date of Provider Agreement
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/hs3
28.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Medicare General Enrollment Health Care 
Provider/Supplier Application
http://www.cms.hhs.gov/cmsforms/downloads/cms855a.p
df
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Health Insurance benefit Agreement
http://www.cms.hhs.gov/cmsforms/downloads/cms1561.p
df
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Home Health Agency Survey and Deficiencies Repor
http://www.cms.hhs.gov/cmsforms/downloads/cms1572a.
pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Civil Rights Information Request for Medicare 
Certification
http://www.hhs.gov/ocr/civilrights/clearance/pregrantchec
klist.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Assurance of Compliance 
http://www.hhs.gov/ocr/civilrights/clearance/hhs690.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Required Forms for a Branch Office to be Licensed:
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Licensure & Certification Application
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/hs2
00.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Medicare General Enrollment Health Care 
Provider/Supplier Application
http://www.cms.hhs.gov/cmsforms/downloads/cms855a.p
df
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Home Health Agency Survey and Deficiencies Repor
http://www.cms.hhs.gov/cmsforms/downloads/cms1572a.
pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Required Forms for a HOSPICE to be Certified with 
Medicaid/Medi-Cal
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Licensure & Certification Application
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/hs2
00.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Notice - Effective Date of Provider Agreement
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/hs3
28.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Medi-Cal Provider Agreement
http://files.medi-cal.ca.gov/pubsdoco/Publications/masters-
other/provappsenroll/21enrollment_DHCS9098.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
health, facility, center, care, hospital, hospice, clinic, 
patient, outpatient, medi-cal, provider, medicaid, chronic, 
dialysis, pediatric, perinatal, dental, cardiovascular, surgery, 
psychiatric, therapy, radiation, renal, respiratory, 
rehabilitation, pathology, audiology, speech, burn, 
coronary, nursery, fire, safety, insurance, hospice, disabled, 
nursing, congregate living, nursing, nurse, 
Last Updated 4/24/2014
GO-Biz Application Forms and Fee Finder
Name of Permit, License, or Registration
Brief Description of Purpose
Application
Fee Information
Keywords
Required Forms for a HOSPICE to be Certified with 
Medicare
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Licensure & Certification Application
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/hs2
00.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Notice - Effective Date of Provider Agreement
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/hs3
28.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Medicare General Enrollment Health Care 
Provider/Supplier Application
http://www.cms.hhs.gov/cmsforms/downloads/cms855a.p
df
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Health Insurance benefit Agreement
http://www.cms.hhs.gov/cmsforms/downloads/cms1561.p
df
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Civil Rights Information Request for Medicare 
Certification
http://www.hhs.gov/ocr/civilrights/clearance/pregrantchec
klist.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Assurance of Compliance 
http://www.hhs.gov/ocr/civilrights/clearance/hhs690.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Hospice
Required Forms to be Licensed:
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Licensure & Certification Application
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/hs2
00.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Application Individual Information
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/hs2
15a.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Fire Safety Inspection Request
http://www.documents.dgs.ca.gov/osp/pdf/std850.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Administrative Organization
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/hs3
09.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Hospice Request for Certification in the Medicare 
Program
http://www.cms.gov/cmsforms/downloads/cms417.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Required Forms to be Certified with Medicaid/Medi-Cal:
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Notice - Effective Date of Provider Agreement
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/hs3
28.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Medi-Cal Provider Agreement
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/dhc
s9098.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Hospice Request for Certification in the Medicare 
Program
http://www.cms.gov/cmsforms/downloads/cms417.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Required Forms to e Certified with Medicare:
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Notice - Effective Date of Provider Agreement
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/hs3
28.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Hospice Request for Certification in the Medicare 
Program
http://www.cms.gov/cmsforms/downloads/cms417.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Hospice Survey and Deficiencies Report
http://www.cms.gov/cmsforms/downloads/CMS643.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Medicare Enrollment Application
http://www.cms.hhs.gov/cmsforms/downloads/cms855a.p
df
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Health Insurance benefit Agreement
http://www.cms.hhs.gov/cmsforms/downloads/cms1561.p
df
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Civil Rights Information Request for Medicare 
Certification
http://www.hhs.gov/ocr/civilrights/clearance/pregrantchec
klist.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Assurance of Compliance 
http://www.hhs.gov/ocr/civilrights/clearance/hhs690.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Adding Alternate Site to Hospice
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Licensure & Certification
http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/hs2
00.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Hospice Survey and Deficiencies Report
http://www.cms.gov/cmsforms/downloads/CMS643.pdf
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Medicare Enrollment Application
http://www.cms.hhs.gov/cmsforms/downloads/cms855a.p
df
http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertFeeL
isting13.pdf
Intermediate Care Facilities for the Developmentally 
Disabled
Last Updated 4/24/2014
Documents you may be interested
Documents you may be interested