LIC 308. Designation of Facility Responsibility


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What is LIC 308 Form?

LIC 308 is known as Designation of Facility Responsibility. This document is widely used in licensed facilities in California. The form was created by the California Department of Social Services Community Care Licensing. It is required whenever you want to send the authorized person that represents the whole facility. In this case, you on behalf of the facility need to provide the information about both the facility and the person.

This form will not work if you don’t have a license, the person is not authorized to accept reports or represent the place, or you have a different type of facility that does not match demands.

The document has to be proof of authorization that the professional receives from the licensee. It grants the right to give or receive documents from the facility, including consultations, inspections, and monthly reports. The person acts on behalf of the organization. Every type of facility has its own demands. Each of them must fill this form with the specific title, including Residential Care Facility, and Child Care Facility.

Form LIC 308 on PDFLiner

What I need the LIC 308 Form for?

  • You need LIC 308 designation of facility responsibility form if you are a member of a licensed facility that has to provide specific rights to the representative that acts on behalf of the company. This person can’t receive any licensing reports until the form will be applied as proof of your arrangements;
  • Licensed professionals can’t begin the work without the form approved by the authorities to represent the mentioned facility. This person can’t gather any reports, make inspections, or organize consultations until the form will be accepted;
  • The form is required by the State of California Health and Human Services Agency to make sure that the person who acts on behalf of the licensed facility is not a fraud.

How to Fill Out LIC 308 Form?

You can download the LIC 308 form on PDFLiner. The form is available for free for anyone who is registered there. You can enter it and fill it online. Once you complete all the sections there, you need to save the copy on your device. Send one of the copies to the authorities and to the licensee if it is required.

You can print the form in advance, fill it out manually and hand it to the authority. If you need to provide the paper version, you still can complete the document online and later just print it. The form requires your signature, but you can use PDFLiner’s tool to create your own electronic signature. Here is what you need to include inside:

  1. Type the name of the facility in the first column;
  2. Put the current date near the name;
  3. Write down the facility number, and facility address, including the phone, county, and the city the facility located at;
  4. Write down the name of the person that you designate to attend the event or to act on your behalf;
  5. Put the signature, title, and address with the ZIP code, county, and city.

Organizations that work with LIC 308 Form

  • State of California Health and Human Services Agency.
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