Get Lic 837 - Request For Audit Services - Dss Cahwnet

The LIC 837 form is an essential document used for requesting audit services from the California Department of Social Services. This guide aims to provide clear, step-by-step instructions on how to complete the LIC 837 online to ensure your request is properly submitted.

Follow the steps to fill out the LIC 837 form online.

1. Click ‘Get Form’ button to access the LIC 837 form and open it in your selected editor.
2. Begin filling out the form with your licensee name and business name. Remember to attach the facility profile as instructed.
3. In the 'Check One' section, select the type of audit service you are requesting — Trust Audit, Solvency Audit, or Other.
4. Provide the facility license number(s) and indicate whether you believe there is a safety risk situation for licensing staff by checking 'Yes' or 'No'.
5. Respond to the questions regarding whether administrative action is planned, denial of new application is planned, if the District Attorney is involved, and if it has been referred to Investigations, selecting 'Yes' or 'No' accordingly.
6. Include the date when the Statement of Facts was signed and the Investigative Case Number if applicable.
7. For Part A, specify details related to the Trust Audit, including any relevant attachments such as the LIC 405 and LIC 402.
8. For Part B, indicate necessary documents related to the Solvency Audit, such as the LIC 401 Monthly Operating Statement and LIC 809 reports.
9. In Part C, complete the credit check information, ensuring to include the names and addresses of all relevant parties.
10. Provide the Group Residence Locator (GRL) information in Part D, including the specific address and zip code you wish to check.
11. If applicable, complete Part E regarding the Certificate of Good Standing or Certificate of Suspension for corporations.
12. Once all fields are filled out accurately, review your entries to ensure they are correct, then save your changes.
13. Download, print, or share the form as needed for your submission.

Get started on completing your LIC 837 form online today.