How to Fill Out the LIC 9214: Prerequisites, Section-by-Section, and Mailing

To fill out the LIC 9214, California’s Application for Administrator Certification, you complete your training, pass the state exam, and clear your Live Scan background check first, then fill in the form’s five short sections, attach the supporting documents, and mail the package with a $140 check to the Administrator Certification Bureau in Sacramento.¹ Initial applications can only be submitted by mail, and the Bureau typically takes up to 90 days to begin reviewing a completed package, so getting it right the first time matters.²

Finish These Three Things Before You Open the Form

The LIC 9214 is the last step, not the first. If you haven’t finished the items below, the form will sit incomplete.

You must be at least 21 years old and hold a high school diploma or GED equivalent.³ From there:

Initial Certification Training Program (ICTP)

Complete an ICTP through a vendor approved by the Administrator Certification Bureau. Required hours depend on the facility type you’re pursuing: 35 hours for ARF, 80 for RCFE, 40 for Group Home, and 40 for STRTP.⁴ Courses from unapproved vendors won’t count, and there is no way to get credit after the fact, so confirm the vendor’s status before enrolling.

If you already hold a valid Nursing Home Administrator license from the California Department of Public Health, you’re exempt from both the ICTP and the written exam. Instead you complete 12 hours of classroom instruction covering RCFE laws and regulations, medication management, and resident admission and assessment procedures.⁵

The State Exam

After finishing the ICTP, you have 60 days and up to three attempts to pass the state written exam. The $100 exam fee covers all three attempts within that window.⁶ Miss the window or fail all three tries and you start over: new ICTP, new fee, full hours again. This is where applicants lose the most time and money.

Criminal Record Clearance

California Health and Safety Code Sections 1522 and 1569.17 require you to submit fingerprint images through Live Scan to the Department of Justice and FBI.⁷ Pay the Live Scan operator’s rolling fee (typically $20 to $50) plus DOJ and FBI processing fees at the time of fingerprinting. Results go directly from the DOJ to CDSS; you don’t carry them yourself.

Walking Through the Form Section by Section

Download the current LIC 9214 from the CDSS Certification Forms page.⁸ The form is one page, but a few fields trip people up.

Section 1: Type of Application

Check “New” for an initial certification. The renewal and certificate number fields are only for renewals or reapplications after a lapse. If you’ve never held this certification before, “New” is your only option.

Section 2: Type of Program

Select one facility type: ARF, GH, RCFE, or STRTP. One per form. If you need certification for more than one facility type, submit a separate LIC 9214, with a separate fee, for each.

Section 3: Applicant Information

Print your full legal name, current mailing address, phone number, cell number, email, Social Security Number, and date of birth. Four yes-or-no questions follow:

(a) Whether you hold or previously held any professional license or certification, such as a nursing license, NHA, or existing administrator certificate. If yes, list the type and number.
(b) Whether you hold or previously held a state-issued care facility license. If yes, provide the license type and number.
(c) Whether you are currently, or were previously, employed at a state-licensed care facility. Give the facility name and license number, and mark current employers with an asterisk.
(d) Whether you have been the subject of any legal or administrative action involving the licenses or certifications in the previous questions. If yes, explain the circumstances and dates, and attach extra pages if needed.

Answer honestly. A “yes” to question (d) doesn’t automatically disqualify you, but failing to disclose something the Bureau later discovers likely will.

Section 4: Certificate Expiration Preference

Initial applicants pick when the certificate expires: two years from the date it’s issued, or your birthday in the second calendar year after issuance. The birthday option can make your first term slightly longer or shorter than two full years. The choice is permanent. If you leave both boxes blank, the default is two years from issuance.

Section 5: Signature and Date

Sign and date the form. An unsigned application comes back to you.

What to Mail With the Form

The LIC 9214 by itself isn’t a complete application. Your envelope needs:

Your ICTP completion certificate from the approved vendor. NHA-exempt applicants include proof of the 12 hours of classroom instruction instead.⁹
Documentation that you passed the state written exam, or documentation of your exemption.
The LIC 508B Criminal Record Statement, signed and dated. This declaration accompanies your Live Scan clearance and is available on the CDSS forms page.¹⁰
A check or money order for $140, made payable to “CDSS–ACB.” Include a photocopy of the check or money order as proof of payment.³

A missing document is the single most common reason applications stall. Walk the list once more before you seal the envelope.

Where to Send It and What Happens Next

Mail the complete package to:¹¹

CDSS – ACB
744 P Street, MS 9-15-807
Sacramento, CA 95814

There is no online submission option for initial applications. The Bureau’s online portal is only available for renewals.³ Certified mail with a return receipt gives you a tracking number and proof of delivery, which is worth the small extra cost over a 90-day window.

The Bureau typically begins reviewing an application within 90 days of receiving it.² If anything is missing or unclear, you’ll get a letter at the address on your form, so keep that address current. Once approved, your formal administrator certificate arrives by mail, and only then can you legally serve as an administrator of a licensed facility.

If You’re Renewing Instead of Applying New

The same form is used for renewals, but almost nothing above applies. Certificates are valid for two years. To renew, submit a LIC 9214 marked as a renewal, pay the $140 renewal fee, and provide proof of your 40 hours of approved continuing education for the cycle (at least four of those hours must cover laws, regulations, policies, and procedural standards for your facility type).¹² Renewals can go through the Bureau’s online portal; eligible administrators receive login instructions by email from NoReplyAdminCert@dss.ca.gov.¹

Submit the renewal or finish your continuing education after the expiration date and you owe a $300 delinquency fee on top of the $140. If your certificate has been expired more than two but less than four years, you owe double the normal continuing education hours. Four years or more past expiration, you can’t renew at all; you reapply as a new applicant and repeat the ICTP and exam.⁸

1
California Department of Social Services. Administrator Certification Bureau (ACB)
2
California Department of Social Services. Administrator Certification Initial Procedures
3
California Department of Social Services. Frequently Asked Questions – Administrators
4
California Department of Social Services. List of Approved Vendors
5
Legal Information Institute. Cal. Code Regs. Tit. 22, 87406 – Administrator Certification Requirements
6
California Department of Social Services. Exam FAQ
7
California Legislative Information. California Code Health and Safety Code 1569.17
8
California Department of Social Services. Certification Forms
9
New York Codes, Rules and Regulations. 22 CCR 87406 – Administrator Certification Requirements
10
California Department of Social Services. LIC 508B – Criminal Record Statement
11
California Department of Social Services. Administrator Information
12
California Department of Social Services. Administrator Certification Renewal Procedures