Get Bcal 1609

The Bcal 1609 is a vital document for facilities seeking certification in specialized programs for individuals with mental illness or developmental disabilities. This guide will provide a clear, step-by-step process for completing the form online, ensuring that all necessary information is accurately submitted.

Follow the steps to successfully complete the Bcal 1609 online.

1. Click 'Get Form' button to obtain the Bcal 1609 and open it in your preferred editor.
2. Begin by providing the facility information in Section I. Indicate the type of application by selecting 'Initial' or 'Modification' and specify any changes if applicable. Enter the effective date of change if relevant.
3. In the same section, specify the certificate type based on the population served, choosing from options such as Mental Illness, Developmental Disability, or both.
4. Fill out the facility name, full street address, city, state, zip code, telephone and fax numbers, and email address if applicable. If the facility's mailing address differs, be sure to include that information as well.
5. Complete additional fields for county, township, AFC license number, licensed capacity, current occupancy, AFC expiration date, and the number of individuals residing in the facility with specialized compensation needs.
6. Proceed to Section II to enter the Adult Foster Care licensee's information. Fill in the name of the licensee, the designee if applicable, and their street address, city, state, zip code, telephone, fax numbers, and email address.
7. In Section III, provide the placing agency information, including the agency name, contact person, and their street address along with corresponding city, state, zip code, telephone, fax numbers, and email address.
8. Next, move to Section IV to indicate the staff-to-resident ratio for each shift, including AM, PM, and midnight shifts.
9. In Section V, detail the specialized program(s) provided, attaching additional sheets if necessary to provide comprehensive information.
10. Finally, review Section VI where the applicant must certify that all relevant regulations have been read. Include the name of the Adult Foster Care licensee, obtain the signature of the licensee or licensee designee, and enter the date signed.
11. Once all sections are complete and verified, save your changes, download the completed document, print a copy, or share it as needed.

Begin filling out the Bcal 1609 online today to ensure your compliance and certification.