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CALIFORNIA DEPARTMENT OF JUSTICE (California)

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CALIFORNIA DEPARTMENT OF JUSTICE
ORI Notification Packet
for
Individuals utilizing an
In-Home Supportive Services Care Provider
Pursuant to
Welfare and Institutions Code 15660
Please read this packet thoroughly as is contains information you will need to begin utilizing applicant live
scan. Included are all of the appropriate DOJ forms you will be utilizing.
Background
The California Department of Justice (DOJ), Bureau of Criminal Information and Analysis (BCIA) provides
criminal history information to employers of persons who are non-licensed and providing
non-medical domestic or personal care to an aged or disabled adult in the adult’s own home. This also
includes applicants for In-Home Supportive Services or personal care services under Medi-Cal program
administered by individual county agencies pursuant to Section 15660 of the Welfare and Institutions Code.
No Federal Bureau of Investigation (FBI) background checks can be requested pursuant to this law.
As defined:
“Elder” means any person residing in this state, 65 years of age or older;
“Dependent Adult” means any person residing in this state between the ages of 18 and 64, who has
physical or mental limitations which restrict his or her ability to carry out normal activities or protect
his or her own rights.
“Request for Live Scan Service” Form (BCII 8016) for IHSS
Effective July 1, 2005, all applicant fingerprint submission must be transmitted electronically to the DOJ.
The standard form available from the DOJ for requesting live scan service is the “Request for Live Scan
Service” Form (BCII 8016). You must complete one form per applicant and 3 copies must be printed out
for each individual to be taken to the live scan site for fingerprinting.
A copy of the BCII 8016 is included within this packet. The BCII 8016 contains an applicant’s personal
descriptor information along with your related data. This information along with an applicant’s fingerprint
images, are necessary for a live scan transaction to be submitted to the DOJ.
Please Note: The Employer Field on the BCII 8016 Form is a REQUIRED Field. As the employer, please
enter your name, address, city, state and zip code. The DOJ utilizes these fields in order to accurately mail
the DOJ Response to your address.
ELDER CARE EMPLOYERS
WELFARE AND INSTITUTIONS CODE 15660
1
Applicant Processing Fees
Once you have provided the necessary form to your applicant, he/she can determine where to be
fingerprinted. The DOJ applicant processing fee for Elder Care license is $32, which is payable by you or
the applicant at the live scan site.
Fingerprinting services are available at most local police departments, sheriff's offices or any public
applicant Live Scan site. To find the sites nearest to your agency and a listing of their rolling fees, see
http://ag.ca.gov/fingerprints/publications/contact.php.
Please note: The applicant must present valid photo identification when being
fingerprinted. Expired identification information will not be accepted. In addition, the live
scan site charges a fee for rolling the fingerprints of the applicant.
Applicant Background Check Status Inquiries
Due to the on-going fiscal crisis and hiring restrictions within State government, the California DOJ no
longer has the resources to take phone calls or process follow-up inquiries from regulatory entities or
individuals who have submitted a criminal offender record information search request through the DOJ or
the Federal Bureau of Investigation (FBI).
Please utilize or advise your clients to use the automated Integrated Voice Response System (IVRS) at
(916) 227-4557 to determine the status of the background check if the requesting agency does not have
results within seven days and digital Live Scan fingerprints were submitted.
You will need the following information:
(1) the applicant's date of birth; and
(2) the 10-digit Automated Transaction Identifier (ATI) number that appears at the bottom of the DOJ
form (BCII 8016) requesting Live Scan fingerprint background checks. The ATI number always appears in
the following sequence: 1 LETTER; 3 NUMBERS; 3 LETTERS and 3 NUMBERS.
No Longer Interested (NLI) Form
It is your responsibility to immediately notify the DOJ when an applicant’s employment has been terminated,
if they were not hired or when an applicant or volunteer is not actually retained to the position for which they
applied. Included in this packet is the NLI form you will complete and return to the DOJ for these purposes.
Attorney General’s Website
The Attorney General’s website located at the following URL
The Attorney General’s website located at the following URL: http://ag.ca.gov/fingerprints/agencies.php
is an additional resource for your agency, which provides a wealth of information including Frequently
Asked Questions, all the forms contained in this notification packet, contact information, locations of live
scan sites and other important DOJ forms you may need for processing background requests.
Authorization for Criminal History Information - Continued
2
Type of License/Certification/Permit OR Working Title (Maximum 30 characters - if assigned by DOJ, use exact title assigned)
Applicant Submission
ORI (Code assigned by DOJ)
Authorized Applicant Type
Contributing Agency Information:
Mail Code (five-digit code assigned by DOJ)
Street Address or P.O. Box
City
State
ZIP Code
Contact Name (mandatory for all school submissions)
Contact Telephone Number
Applicant Information:
Last Name
First Name Middle Initial
Suffix
Other Name
(AKA or Alias)
Last
First
Suffix
Date of Birth
Sex
Male
Female
Driver's License Number
Height
Weight Eye Color
Hair Color
Place of Birth (State or Country)
Social Security Number
Home
Address
Street Address or P.O. Box City State ZIP Code
Billing
Number
(Agency Billing Number)
Misc.
Number
(Other Identification Number)
Your Number:
OCA Number (Agency Identifying Number)
Level of Service:
DOJ FBI
If re-submission, list original ATI number:
(Must provide proof of rejection)
Original ATI Number
Employer (Additional response for agencies specified by statute):
Employer Name
Street Address or P.O. Box
City
State
ZIP Code
Mail Code (five digit code assigned by DOJ
Telephone Number (optional)
Live Scan Transaction Completed By:
Name of Operator Date
Transmitting Agency LSID ATI Number Amount Collected/Billed
ORIGINAL - Live Scan Operator SECOND COPY - Applicant THIRD COPY (if needed) - Requesting Agency
DEPARTMENT OF JUSTICE
BCII 8016
(orig. 4/01; rev. 6/09)
REQUEST FOR LIVE SCAN SERVICE
STATE OF CALIFORNIA
Agency Authorized to Receive Criminal Record Information
ELDER CARE
CA0349400
ELDER CARE
4949 BROADWAY
SACRAMENTO
CA
95820
DEPARTMENT OF JUSTICE
STATE OF CALIFORNIA DEPARTMENT OF JUSTICE
BCIA 8302
(Orig. 03/2006; Rev. 09/2012)
NO LONGER INTERESTED (NLI) NOTIFICATION
(FOR NON-DEPARTMENT OF JUSTICE APPLICANTS)
PAGE 0 of 0
California Penal Code section 11105.2(d) states, in part, that any agency which submits the fingerprints of applicants
for employment or approval to the Department of Justice for the purpose of establishing a record of the applicant to
receive notification of subsequent arrests, shall immediately notify the department when employment is terminated or
the applicant is not hired.
It is the responsibility of hiring/approving authority to notify the Department of Justice, Bureau of Criminal Information
and Analysis when employment has been terminated or when an applicant or volunteer is not actually retained to the
position for which they applied.
APPLICANT INFORMATION (Please type or print in ink):
*NAME (MANDATORY):
LAST FIRST MIDDLE
ALIASES (MAIDEN NAME, AKAs)
LAST
FIRST
MIDDLE
SEX
MALE FEMALE
*DATE OF BIRTH (MANDATORY)
CII NUMBER
*APPLICATION TYPE (MANDATORY)
(Specific to requesting agency i.e., credentialed, classified, volunteer, non-sworn, license, permit, peace officer, etc.)
AGENCY INFORMATION:
*AGENCY NAME AND ADDRESS (MANDATORY) AGENCY ORI (MANDATORY)
CONTACT PERSON
* FORM MUST BE FILLED OUT COMPLETELY TO ENSURE TIMELY PROCESSING.
Mail or Fax this notification to:
DEPARTMENT OF JUSTICE
BUREAU OF CRIMINAL INFORMATION AND ANALYSIS
P.O. BOX 903417
SACRAMENTO, CA 94203-4170
TELEPHONE (916) 227-1996
FAX (916) 227-4722
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Completed 12 March 2021

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