How to Complete the California LIC 9163 Request for Live Scan Service

The California LIC 9163 form is the Request for Live Scan Service you complete before being fingerprinted for a California Department of Social Services background check. To fill it out correctly, download the current version from the CDSS Live Scan page, enter ORI code A0448 so your results route to Community Care Licensing, check the box for your working title, enter the Authorized Applicant Type code and your facility number, complete your personal information exactly as it appears on your ID, print two copies, and bring both along with valid photo identification to an authorized Live Scan site.¹ Errors in any single field can delay or derail your clearance, so the form deserves careful attention before your appointment.

Who Uses Form LIC 9163

You use this form if you are a license applicant, licensee, employee, adult resident (other than a client), volunteer, resource family applicant, or home care aide registry applicant tied to a community care facility in California.² That covers foster parents, child care workers, adult residential facility staff, group home employees, and similar roles. California law requires anyone who works, lives, or volunteers in a licensed community care facility to clear both a Department of Justice and FBI criminal history screening before being present at the facility.³ You must have either a criminal record clearance or an exemption on file before your first day. There is no grace period for working while results are pending unless specific interim-presence rules apply at the facility.

Download the Current Version

Pull the form directly from the CDSS Live Scan page each time you need it. Do not reuse old copies kept in a facility’s back office. The form was revised in January 2025, and outdated versions may contain the wrong codes or missing fields that cause CDSS or the DOJ to reject your submission.

Some parts of the form are pre-printed, some get completed by the Live Scan operator at your appointment, and the rest are your responsibility. Work through it in order, and do not sign anything until you have reviewed every field for accuracy.

Agency and Facility Fields

The ORI (Originating Agency Identifier) at the top of the form must read A0448. This is the code that routes your background check results to CDSS Community Care Licensing. If a different ORI appears, your results go to the wrong agency and your clearance stalls while you track down what happened.

The contributing agency block below the ORI is pre-printed on the current form. It lists the California Department of Social Services at PO Box 94244, Mail Station T9-15-62, Sacramento, CA 94244-2430, with a DOJ mail code of 03502. You do not need to fill this in, but check that it is actually present. If the block is blank, you have an outdated form.

Next, check the box for your working title. The options are Employee, Adult Resident other than Client, License/Certification Applicant, Volunteer, RFA Relative, and Home Care Aide Registry Applicant. Pick the one that matches your actual role at the facility, not the role you expect to have later.

Below that, enter the Authorized Applicant Type. This is an abbreviation code listed on page two of the form that corresponds to the specific type of facility or organization you are associated with. Use the code from the current form rather than one you remember from a prior submission. Then enter the facility or organization number assigned to the licensed location where you will work or reside. The facility administrator can give you this number if you do not have it.

Personal Information

Enter your full legal name in last, first, middle initial order. Add any aliases or prior names you have used, including maiden names and legally changed names. Fill in your date of birth, sex, place of birth, and Social Security number.

The SSN field is technically voluntary under the privacy statement on the form, but leaving it blank slows processing because the DOJ uses it as a key matching identifier. Including it is usually the practical choice.

Fill in your physical descriptors: height, weight, eye color, and hair color. These are used for identity verification during the records search, so use honest current numbers rather than estimates from a decade ago. Everything on the form is submitted under penalty of perjury. Under California Penal Code section 118, knowingly stating false material information under penalty of perjury is a felony punishable by two, three, or four years in state prison.⁴ Review every field before printing.

Print Two Copies

Print two copies of the completed form and bring both to your appointment. The Live Scan operator keeps one copy after completing Section 8 (the transaction details), and you keep the other. Hold onto your copy until you receive formal notification that your clearance is on file. It contains the codes you will need to troubleshoot if CDSS says it never received your results.

At the Live Scan Appointment

Find an authorized Live Scan site through the Department of Justice directory at oag.ca.gov/fingerprints/locations.⁵ Sites include law enforcement offices, shipping stores, dedicated background screening businesses, and some government offices. Not every location serves every type of applicant, so confirm before you go that the site handles CDSS community care submissions.

Bring your two printed copies of Form LIC 9163 and a valid, unexpired photo ID. Expired identification will not be accepted.⁵ A California driver’s license or ID card is the most straightforward option, though other government-issued photo IDs are generally accepted.

The operator scans your fingerprints electronically and transmits them directly to the DOJ. At the end of the session, the operator fills out Section 8 of the form and gives you an Automated Transaction Identifier (ATI) number, a ten-digit code printed at the bottom of your copy. Note that receiving an ATI number does not guarantee your prints reached the DOJ. The ATI is generated by the Live Scan device itself, not by the DOJ’s system.⁶ Confirm through the status portal rather than assuming the submission went through.

What You Will Pay

You pay three separate charges at the Live Scan site: a state processing fee to the DOJ, a federal processing fee to the FBI, and the operator’s service fee. The state and federal amounts depend on the type of facility and your role. The most common tiers from the DOJ’s published fee schedule are:⁷

General (most employees and license applicants): $32 state, $17 federal.
Child day care or residential care, small or home-based: $0 state, $17 federal.
Adult day or residential care: $42 state, $17 federal.
Child day care or residential care, large facility: $42 state, $17 federal.
Emergency child placement: $0 state, $17 federal.

The operator’s service fee covers equipment and labor. The state does not regulate this charge, so it varies by location, with most operators charging somewhere in the range of $20 to $45. For someone in the general category, total out-of-pocket usually lands around $69 to $94.

Tracking Your Results

The DOJ runs an online status portal at applicantstatus.doj.ca.gov. Enter your ATI number and date of birth to see whether your fingerprints have been processed.⁶ This status reflects the fingerprint check only. It does not tell you anything about your employment or licensing status with CDSS, which involves additional steps on the department’s side.

If your prints do not match any existing records, the check typically processes electronically within 48 to 72 hours. If they do match records in the system, a DOJ technician manually reviews the associated criminal history, and that review can take significantly longer. The DOJ does not publish a fixed timeline for manual review.⁶ Results go directly from the DOJ to CDSS Community Care Licensing, not to you. CDSS then matches the results to your facility file and issues a clearance or takes further action.

If Your Fingerprints Are Rejected

Rejections happen more often than most applicants expect, and the cause is usually not something you did wrong. Dry or cracked skin, faded ridges (common in older adults and people who work with their hands), excessive moisture, and scanner calibration issues all produce unreadable prints. Mismatched personal information on the form, such as a misspelled name or transposed SSN digits, can also trigger a rejection even when the prints themselves are clean.

If your prints are rejected, return to a Live Scan site for a recapture and bring the rejection notice so the operator can address the specific problem. To improve your odds on the retake, moisturize your hands in the days before but skip lotion the day of, stay hydrated, and arrive with hands dry and at room temperature.

If the DOJ rejects your prints a second time for poor quality, the DOJ will run a name-based search of its own state criminal history database using your personal information. The FBI side works differently. Your facility or requesting agency must submit Form BCIA 8020 to the DOJ’s FBI Response Unit to request a name-based check of the FBI national database, and that form must reach the DOJ within 75 calendar days of the second rejection notice. After 90 days, the FBI deletes the fingerprint transaction entirely, and you would start over with a fresh set of prints.⁶

1
California Department of Social Services. Live Scan Application Process and Associated Fees
2
California Department of Social Services. Background Check Process
3
California Legislative Information. California Health and Safety Code 1522 – Administration
4
California Legislative Information. California Code PEN 126 – Perjury Punishment
5
State of California – Department of Justice – Office of the Attorney General. Live Scan Locations
6
State of California – Department of Justice – Office of the Attorney General. Fingerprint Background Checks
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State of California Department of Justice. Applicant Fingerprint Processing Fees