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  • Mi Bcal-1326a 2016

Get Mi Bcal-1326a 2016-2026

AFC/HFA LICENSING RECORD CLEARANCE REQUEST Administrator Responsible Person or Adult Member of Household Only STATE OF MICHIGAN Department of Licensing and Regulatory Affairs Bureau of Communit and Health S stems DIRECTIONS FOR COMPLETING FORM Type or print CLEARLY so that the information provided can be read. Mail the completed form to the Bureau of Community and Health Systems BCHS at the address below. Michigan Department of Licensing and Regulatory Affairs P O Box 30664 Lansing MI 48909 Licensin Consultant if known REQUESTOR INFORMATION LICENSEE/APPLICANT NAME NAME OF FACILITY COUNTY LICENSE NUMBER AFC Group Home AFC Family Home THE PERSON BEING CLEARED IS CHECK ONLY ONE BOX Note Administrators or Responsible Persons are to be cleared through the Workforce Background Check Program. Website https //miltcpartnership.org/ Responsible Person Adult Member of Household CLEARANCE INFORMATION PRINT CLEARLY NAME Last First Middle Jr. Michigan Department of Licensing and Regulatory Affairs P....

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How to fill out the MI BCAL-1326A online

The MI BCAL-1326A is a crucial form for individuals seeking licensing records clearance in Michigan. This step-by-step guide will help you navigate the online filling process effectively and clearly.

Follow the steps to complete the MI BCAL-1326A form online.

  1. Press the ‘Get Form’ button to access the MI BCAL-1326A form and open it for editing.
  2. Enter the requestor information by providing the licensee or applicant's name, facility name, county, license number, and the type of license or application.
  3. Specify the person being cleared by checking the appropriate box for Administrator, Responsible Person, or Adult Member of Household.
  4. In the clearance information section, print clearly and provide the full name, marital status, gender, social security number, aliases, address, city, birth date, Michigan driver's license or state ID number, county, ZIP code, phone number, race, height, and any other states lived in during the past five years.
  5. Indicate how long you have lived in Michigan and how long you have resided in the current county.
  6. Answer the question regarding any past convictions by checking 'Yes' or 'No.' If 'Yes', provide details about the type, location, and date of conviction(s) on a separate sheet if necessary.
  7. Sign and date the form in the designated area, ensuring your signature is clear.
  8. Once all fields are completed, save the changes, then download, print, or share the completed MI BCAL-1326A form as needed.

Complete your MI BCAL-1326A form online today for an efficient clearance process.

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You must file an application with the state, which will review the application and provide a license if you satisfy all criteria for your type of adult foster care home. The state wants to determine whether you can handle emergencies and whether you have the appropriate temperament to care for the elderly.

What is a Child Care Background Check? A child care background check is a both a fingerprint-based and name-based check that will cover the following: Michigan State Police (MSP) fingerprint-based check of criminal history. Federal Bureau of Investigation (FBI) fingerprint-based check of criminal history.

Adult Foster Care (AFC) homes are licensed residential settings that provide 24-hour personal care, protection, and supervision for individuals who are developmentally disabled, mentally ill, physically handicapped or aged who cannot live alone but who do not need continuous nursing care.

Special Note: The State of Michigan does not license assisted or independent living facilities. Please note, however, that a Home for the Aged or Adult Foster Care Home license may be required if the level of care provided at the facility meets the licensing requirements of one of these license types.

Pricing by room type Room typesAverage monthly costShared Suite$3,324Private Suite$3,988

A Licensing Information Request form will need to be completed and submitted for members of the household (18 years of age or older, who live in the home and are not foster care residents) and all responsible persons. If additional forms are needed, please contact the Licensing Unit at 1-866-856-0126.

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