Follow the steps to complete the application efficiently.

1. Click the ‘Get Form’ button to access the document, then open it in the editor.
2. At the top of the form, provide essential information such as the reporting period, facility name, facility address, and application or license number.
3. Fill in the revenue section by detailing the SSI monthly rate, the number of SSI clients, and any third-party contributions.
4. Report private revenue by indicating the number of private pay residents and their average monthly rates.
5. Detail other facility-related revenues, adding any necessary worksheets if required space exceeds what's available.
6. Complete the operating costs section by providing costs for food, household supplies, personal hygiene items, and more.
7. In the general administration section, report costs related to salaries, taxes, insurance, and any contract labor.
8. Detail physical plant costs such as rent or mortgage payments, utility bills, and maintenance expenses.
9. Calculate the total operating costs by summing the relevant sections, and report the net profit or loss.
10. Finally, print your name in the preparer section and ensure the applicant or licensee signs and dates the form to attest to its accuracy. Save your changes, and consider downloading or printing the completed document for your records.

Start completing your - Cdss Ca form online today for streamlined document management.