Section A — Licensing Application Forms ~45 min

How to Fill Out the HCS 200 Form (California Home Care License Application)

The HCS 200 is the "Face Page" of your entire application. It tells the state exactly who owns the business, where it is located, and when they can reach you. Answer the questions honestly as things stand right now—you can always update the state later as your business grows.

Demystifying the HCS 200 Form

The state uses this form to establish the baseline facts of your agency. Here is exactly how to think about the most confusing questions:

Applicant Name vs. Home Care Organization Name

If you formed an LLC or Corporation, the "Applicant" is your company's legal name (e.g., "Golden Years Care, LLC"). The "Home Care Organization Name" is the name you actually present to the public (e.g., "Golden Years Home Care"). If they are the same, just enter it twice!

Business Office Hours

The state requires you to list specific hours. Why? Because state inspectors are allowed to conduct unannounced visits, and they need to know when your doors are open.

Do not put 24/7. Even if your caregivers work 24/7, your office* is not open 24/7.
  • The safest bet: Put standard hours like "Monday - Friday, 9:00 AM to 5:00 PM." You can always add "On-call 24/7" after the office hours.
Total Number of Home Care Aides

Don't overthink this! If you are just starting out and haven't hired anyone yet, it is perfectly acceptable to write "0" or "1" (if you plan to be the first aide). The state just wants a rough idea of your initial size. No one will audit you if you estimate 5 and end up hiring 10.

The Designee

The "Designee" is the person the state will contact regarding this license. If you are the owner and running the show, this is you. If you hired a dedicated Administrator to run the business, put their name here.

Common Mistakes to Avoid

  • 1Putting a personal name as the "Applicant" when the business is actually registered as an LLC or Corporation. The LLC is the legal applicant.
  • 2Entering 24/7 for "Business Office Hours." The state will reject this because they know your administrative staff is not sitting at desks at 3:00 AM.
  • 3Forgetting to list the "County Where Signed" at the very bottom of the form.

Tips

  • Use the exact legal spelling of your business name, including commas (e.g., "Acme Care, LLC" not "Acme Care LLC"). It must match your Secretary of State filing perfectly.
  • If you work from a home office, your business address and landlord information will just be your home address and your mortgage holder/landlord.

What You Need to Do

  1. 1
    Review the guidance to understand the HCS 200 requirements
  2. 2
    Complete all required data fields above
  3. 3
    Generate, print, and sign the HCS 200

    Use the "Generate PDF" button below. You must sign box 17 with blue or black ink.

Information You Will Need

Have these details ready before you sit down to fill this out:

Requested Action

Most new agency owners will select "Initial Application." Only choose another option if you are renewing, relocating, or purchasing an existing agency.

Required
If "Other," please specify

Only fill this in if you selected "Other" above.

Applicant Name (Your Legal Entity)

If you formed an LLC or Corp, put the exact legal name here (e.g., "Smith Care LLC"). If you are a Sole Proprietor, put your full legal name.

Required
Application Filed By (Entity Type)

Select how your business is legally structured with the state. This should match what you chose in step CA_0_2.

Required
Home Care Organization Name (DBA)

The name the public will see. If it is the same as your legal entity above, just type it again.

Required
Physical Office Street Address

Where is your administrative office located? No PO Boxes allowed for the physical address.

Required
Mailing Address

Where should the state mail your physical license? PO Boxes are allowed here. Leave blank if same as physical office.

Business Phone Number

The main phone number clients and the state will use to reach your office.

Required
Business Email Address

Use a professional email (e.g., hello@youragency.com) rather than a personal Gmail if possible.

Required
Designee Full Legal Name

Who is the main point of contact for this license? (Usually you, the owner, or your hired Administrator).

Required
Designee Title

What is this person's official role?

Required
Total Number of Home Care Aides

Just your best estimate for launch day! Entering "0" or "1" is completely fine if you are just starting out.

Required
Business Office Hours

When is your administrative staff actually in the office? State standard is usually Mon-Fri 9am-5pm. Do NOT put 24/7.

Required
Office Property Ownership

Do you own or rent the physical office space?

Required
11A. Landlord / Property Owner Name

Required if you selected Rent/Lease above.

Landlord / Property Owner Address
Landlord / Property Owner Phone
Was this Home Care Organization previously licensed?

Only check yes if you bought an existing agency or let a previous license expire.

Required
Do you currently operate any other state-licensed care facilities?

This includes community care facilities, residential care facilities (including for the elderly or persons with chronic life-threatening illness), certified family homes, resource families, child day care facilities, day care centers, family day care homes, employer-sponsored child care centers, or other home care organizations.

Required
13A. Other Facility Name

If yes above, enter the name of the facility you currently operate.

13B. Other Facility Address

Street address, city, state, and ZIP of the other facility.

13C. Type of Facility

The category of license the other facility holds.

13D. Facility License Number

The state-issued license number for your other facility.

County Where Signed

What California county are you physically sitting in when you sign this application?

Required

Documents Needed

  • HCS 200 — Main Application (pre-filled)
    RequiredPDF · Max 10MB

Official Resources

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