The LIC 508 O-O-S is a one-page California Department of Social Services form that asks whether you have lived outside California during the past five years, and if so, which states. You download it as a fillable PDF from the CDSS forms library, print your identifying information, check Yes or No, sign under penalty of perjury, and hand it to the licensee running your background check.1California Department of Social Services. LIC 508 O-O-S – Out-of-State Disclosure If you check Yes, you also complete a separate LIC 198B for each state you list. The form is part of the caregiver background check required under California Health and Safety Code Section 1522 before anyone can work, volunteer, or live in a licensed community care facility, foster family home, or resource family home.2California Legislative Information. Health and Safety Code 1522 – Criminal Record Clearance
Who Has to Complete the Form
Anyone who needs a criminal record clearance or exemption from CDSS before being present in a licensed facility fills out the LIC 508 O-O-S. Under Health and Safety Code Section 1522, that includes applicants to operate a community care facility, certified family home, or resource family home; administrators and supervisors; adults over 18 who live in a foster family, certified family, or resource family home and are not clients; and direct-care staff and volunteers at childcare centers, group homes, and residential care facilities for the elderly who will have contact with clients.2California Legislative Information. Health and Safety Code 1522 – Criminal Record Clearance
The clearance must be in place before you first set foot in the facility, not after you start.2California Legislative Information. Health and Safety Code 1522 – Criminal Record Clearance Everyone in those roles completes the form, even if you have lived in California your whole life. In that case you simply check No and sign. The signed form goes into your file either way.
What the Form Asks For
The LIC 508 O-O-S is short. The top asks for the name and facility number of the licensed facility, certified family home, or resource family home where you plan to work or reside. Then it collects your personal information:1California Department of Social Services. LIC 508 O-O-S – Out-of-State Disclosure
- Full legal name, printed clearly
- Current address, including street, city, state, and zip code
- Social Security number
- Driver’s license number and issuing state
- Date of birth
Then the core question: “Have you lived in a state other than California within the last five years?” You check Yes or No. If Yes, you list each state on the lines provided. There are four lines; attach a separate sheet if you lived in more than four states. The form itself does not ask for addresses or dates. That detail goes on the LIC 198B.
At the bottom, you sign and date a declaration under penalty of perjury that your answers are true.
Filling It Out Step by Step
Get the facility name and facility number from your employer or the licensee before you start. This is their CDSS identifying information and not something you would know on your own. Ask first and save yourself a trip back.
Print your full legal name exactly as it appears on your government-issued ID. Use your current residential address, not a P.O. box. Enter your Social Security number, driver’s license number with the issuing state, and date of birth. Check these against the actual documents. A transposed digit in the SSN can trigger a mismatch with Department of Justice records and delay the whole clearance.
For the residency question, count back five full years from today. If you lived anywhere outside California during that window, even briefly, check Yes and list every state. A summer at a relative’s house in another state counts if that was your residence. If you were in California the entire time, check No.
Sign and date the form in ink. The perjury declaration makes this a legal statement, so do not sign until you are confident everything is accurate.1California Department of Social Services. LIC 508 O-O-S – Out-of-State Disclosure
If You Checked Yes: The LIC 198B
Checking Yes on the LIC 508 O-O-S means you also complete a separate LIC 198B for each state you listed. The LIC 198B is the form that actually authorizes CDSS to contact that state’s child abuse and neglect registry.3California Department of Social Services. Out-of-State Child Abuse/Neglect Report Request
The LIC 198B asks for more than the LIC 508 O-O-S. You will provide:
- Full legal name, including maiden name and any aliases
- Date of birth, SSN, and driver’s license number
- Email address, state of birth, sex, and race
- Addresses for the past five years, with dates, city, state, county, and circumstances of each move
- Whether you have ever been substantiated as a perpetrator in a child abuse or neglect report in any state
This is where the detailed address history lives. Gather your past addresses before you sit down, because each entry needs a city, state, and county with approximate dates. Attach a page if you run out of space. At the bottom you sign an authorization letting CDSS contact the listed states and gather what they need to process the check. If you answer Yes to ever having been substantiated as a perpetrator, a supplemental section asks for details. Answer honestly. CDSS will receive the registry results regardless of what you disclose, and an inconsistency can derail your clearance.
Where to Send It
Hand the completed LIC 508 O-O-S, and any LIC 198B forms, to your employer or the licensee handling your background check. You do not send it to the state yourself. If you disclosed out-of-state residency, the licensee mails both forms to:1California Department of Social Services. LIC 508 O-O-S – Out-of-State Disclosure
Caregiver Background Check Bureau
744 P Street, MS T9-15-62
Sacramento, CA 95814
If you checked No, the licensee keeps the signed form in your file. It still matters. It documents that you were asked and affirmed under penalty of perjury that you had no out-of-state residency.
What Happens After You Submit
The LIC 508 O-O-S and LIC 198B feed into a background check process that runs alongside your Live Scan fingerprinting. When you submit fingerprints at a Live Scan site, the California Department of Justice runs a criminal history check against state and federal databases.4California Department of Social Services. Background Check Process The out-of-state disclosure triggers a separate track called the Out-of-State Child Abuse check, or OSCA.
The OSCA applies specifically to resource parents, adults living in resource family homes under the Adam Walsh Act, and employees of children’s residential agencies under the Family First Prevention Services Act.4California Department of Social Services. Background Check Process CDSS contacts each state you listed and searches its child abuse and neglect registry. You are not eligible to work or reside in the facility until the OSCA check clears. The useful part is that OSCA is a one-time check. Once cleared, you do not need to repeat it unless you move out of state and return.
Processing times vary. Some states charge fees for registry searches, and others have legal restrictions on sharing registry information for employment purposes, which can slow things down.5Administration for Children and Families. States’ Status of and Identified Barriers to Implementation of the Child Care and Development Block Grant Act of 2014 Out-Of-State Background Check Requirements If a state does not respond, CDSS follows up, which extends the timeline.
Mistakes That Delay Your Clearance
Most errors come from rushing or from confusion about which form holds which information.
- Leaving the facility number blank. Ask your employer before you start.
- Writing out full addresses on the LIC 508 O-O-S. That form only asks for state names. Detailed address history belongs on the LIC 198B.
- Forgetting a state. If you lived in three states over the past five years and list only two, the missing state’s registry goes unchecked, and the discrepancy can surface later through other records and force a supplemental check.
- Submitting the LIC 508 O-O-S without the LIC 198B. If you checked Yes, both forms must reach the Caregiver Background Check Bureau together.
- Not signing in ink. The perjury declaration requires an original signature. A pencil signature or unsigned form will be returned.
Fill out both forms completely the first time, hand them to the licensee promptly, and schedule your Live Scan as soon as you can. The criminal history check and the OSCA check run on separate tracks, and your clearance is not final until both come back clean.