Get A0448 Live Scan Form

The A0448 Live Scan Form is an essential document for individuals seeking services related to background checks, particularly in the context of long-term care and social services. This guide will provide you with clear, step-by-step instructions on how to complete this form online efficiently.

Follow the steps to fill out the A0448 Live Scan Form online.

1. Click ‘Get Form’ button to obtain the form and access it in your preferred digital format.
2. Locate the section labeled ‘ORI’ at the top of the document. Enter ‘A0448’ as the unique identifier for this Live Scan request.
3. In the ‘Working Title’ field, input ‘OMBUDSMAN’. This identifies your role or position in relation to the background check.
4. For the ‘Authorized Applicant Type’, select ‘Ombudsman’. This indicates the category under which you are applying.
5. Fill in the ‘Agency Address Set Contributing Agency’ details. Specifically, include ‘CA Dept of Social Services’, with the mail code as ‘03502’.
6. Under ‘Contact Name’, provide the name of the representative responsible for this submission.
7. Complete the ‘Contact Telephone No.’ with the necessary contact number for queries.
8. In the ‘Applicant Information’ section, print your full name as required in the box provided, including last name, first name, and middle initial. Fill out any aliases in the ‘AKA’s’ field.
9. Provide your California Driver’s License number in the ‘CDL No.’ field, followed by your Date of Birth (DOB), identifying your sex as either male or female, and include your height (HT) and weight (WT).
10. If applicable, enter any other identification information in the ‘Misc. No.’ field.
11. Complete eye color and hair color fields based on your physical description.
12. Fill in your home address information in the designated fields, ensuring accuracy.
13. For ‘Facility Number’, input 349822222, which may be provided preprinted.
14. In ‘Level of Service’, ensure both DOJ and FBI boxes are checked according to the requirements.
15. If this is a resubmission due to previous rejection, enter the original ATI number in the space provided.
16. For ‘Employer’, input ‘LTC Ombudsman Program’ along with the required address details, including street number, city, state, and zip code.
17. The section titled ‘Live Scan Transaction Completed By’ will be filled by the Live Scan operator after services are rendered.
18. Once all fields are completed, ensure to save changes, download the form, print it, or share it as needed for submission.

Complete your A0448 Live Scan Form online today for a smooth application process.