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OKDHS Home > Library > Policy > OAC 340 > Chapter 110. Licensing Services > 1. General Provisions > 43.1. Forms
340:110-1-43.1. Forms
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Revised 7-1-11

 

      Forms that apply to this Part are listed in this Subsection.

  • (1) 07LC005E, Transportation Information.  Form 07LC005E is used by a child care facility director to document compliance with licensing requirements on transportation.
  • (2) 07LC012E, Licensing Complaint.  Form 07LC012E is used by licensing staff to record a complaint against a child care facility.
  • (3) 07LC016E, Recommendation for Licensing or Certification of a Child Care Center.  Form 07LC016E is used by licensing staff and supervisors to make recommendations on the licensing or certification of child care facilities.
  • (4) 07LC021E, Comments and Recommendations Regarding Licensing Requirements.  Form 07LC021E is used to make comments and recommendations pertaining to licensing requirements and policy.
  • (5) 07LC022E, Child-Placing Agency - Foster Care File Review.  Form 07LC022E is used by licensing staff to record the agency's compliance or non‑compliance with licensing requirements for foster home care.
  • (6) 07LC037E, Notice to Comply.  Form 07LC037E is used by a facility to document a plan of correction when there is serious or repeated non‑compliance with licensing requirements.
  • (7) 07LC039E, Child Care Staff Health Record.  Form 07LC039E is used to document tuberculosis testing and also used by an examining physician to document an employee's physical exam.
  • (8) 07LC040E, Request for License - Child-Placing Agency, Residential Child Care, and Children's Shelter.  Form 07LC040E is used by an agency or residential facility to request application for a child care facility license.
  • (9) 07LC041E, Staff Information – Child Care Facility.  Form 07LC041E is used to record required information regarding child care facility staff.
  • (10) 07LC043E, Child Placing Agency Compliance Review.  Form 07LC043E is used by licensing staff to assess compliance with child-placing agency requirements.
  • (11) 07LC044E, Adoption Services File Review.  Form 07LC044E is used by licensing staff to record the agency's compliance or non‑compliance with licensing requirements for placement of children for adoption.
  • (12) 07LC047E, Agency Certification Report.  Form 07LC047E is completed by the child-placing agency staff to certify to the Oklahoma Department of Human Services that each foster home or Independent Living arrangement complies with the Licensing Requirements for Child-Placing Agencies.
  • (13) 07LC050E, Personnel File Review – Agency and Residential Programs.  Form 07LC050E is used by licensing staff to document compliance with personnel record requirements in residential and child‑placing agency requirements.
  • (14) 07LC056E, Compliance Review-Residential Child Care Facility.  Form 07LC056E is used by licensing staff to assess compliance with residential requirements.
  • (15) 07LC058E, Monitoring Report-Residential Child Care Facility.  Form 07LC058E is used by licensing staff to document compliance with requirements during a visit to a residential facility and record any other information obtained.
  • (16) 07LC059E, Residential Child Care Facility - Resident File Review.  Form 07LC059E is used by licensing staff as part of the licensing process to document compliance with residential facility requirements.
  • (17) 07LC060E, Residential Child Care Policy and Records Check.  Form 07LC060E is used by licensing staff to document compliance with residential policy and procedure requirements.
  • (18) 07LC065E, Resident Monitoring Report.  Form 07LC065E is used by licensing staff to record the agency's compliance with licensing requirements for independent living programs.
  • (19) 07LC071E, Licensing Services Waiver Referral.  Form 07LC071E is used by licensing staff when submitting a waiver request to State Office.
  • (20) 07LC078E, Child-Placing Agency - Record of Foster Home Closure.  Form 07LC078E is used by a child-placing agency to report closure of a foster home.
  • (21) 07LC079E, Child Death Report.  Form 07LC079E is completed by licensing staff to record the death of a child while in child care.
  • (22) 07LC080E, Licensing Services Supplemental Information.  Form 07LC080E is used when additional space for documentation is needed, when a complete monitoring report is not required, to document office and telephone contacts, and to record other information for the licensing record.
  • (23) 07LC081E, Licensing Complaint Report Summary.  Form 07LC081E is placed in the case record and includes the findings of the investigation in compliance with Section 406 of Title 10 of the Oklahoma Statutes.
  • (24) 07LC087E, Waiver Notification.  Form 07LC087E is used to inform facilities of a decision regarding a waiver request.
  • (25) 07LC089E, Child Care Waiver Request.  Form 07LC89E is used by a program director to request a waiver for persons with a restricted criminal history.
  • (26) 07LC090E, Waiver Reference.  Form 07LC090E is used to obtain references for persons with a restricted criminal history.
  • (27) 07LC092E, Insurance Verification.  Form 07LC092E is completed annually to verify liability insurance coverage.
  • (28) 07LC095E, Notice Regarding Unlicensed Care.  Form 07LC095E is provided to facilities during the investigation of unlicensed care.
  • (29) 07LC096E, Criminal History Review Request.  Form 07LC096E is completed by facilities to request a criminal history review by licensing records office.
  • (30) 07LC097E, Citation Request.  Form 07LC097E is used when requesting assistance of CLEET-certified officers.
  • (31) 07LC098E, District Attorney Referral.  Form 07LC098E is used when requesting a DA file criminal charges and/or issue an injunction.
  • (32) 07LC101E, Restricted Registry Verification.  Form 07LC101E is used by child care facilities and licensing to verify non-registration and registration of individuals recorded on the Child Care Restricted Registry.
  • (33) 07LC102E, Restricted Registry Notification.  Form 07LC102E is used by the licensing records office to notify individuals of potential registration on the Child Care Restricted Registry.
  • (34) 07LC103E, Restricted Registry Final Notification.  Form 07LC103E is used by licensing records office to notify individuals of registration on the Child Care Restricted Registry.
  • (35) 07LC104E, Restricted Registry Notification to Child Care Facility.  Form 07LC104E is used by licensing records office to notify child care facilities of registration of individuals on the Child Care Restricted Registry.
  • (36) 07LC106E, Criminal History Review Results.  Form 07LC106E is used to notify facilities of the results of the criminal history review.
  • (37) Form 07LC107E, Child Care Restricted Registry Notice.  Form 07LC107E is used as additional notification to facility employees of the Child Care Restricted Registry registration process.
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Last Updated:  6/30/2011
Oklahoma Department of Human Services
Street address: Sequoyah Memorial Office Building, 2400 N. Lincoln Blvd., Oklahoma City, OK 73105
Mailing address: P.O. Box 25352, Oklahoma City, OK 73125
(405) 521-3646
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