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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 first form in your packet. It says who is applying, where the agency is, and when it is open. Answer for how things are today.

How to fill out the HCS 200

Here is what the tricky parts mean. Item numbers match the form.

Item 1 — Applicant name vs. item 5 — HCO name
  • For an LLC, item 1 is the LLC name. For a corporation, it is the corporation name (HCS 281).
  • Item 5 is the name of your agency. If they are the same, write it twice.
Item 2 — Requested action

New agency? Check "Initial Application." Buying an agency? Check "Sale" and write that agency's HCO number.

Items 3 and 7 — Mailing addresses

CDSS mails all letters to the address you give (HCS 281). Use one you check often.

Item 5 — Phone and email

CDSS calls this number to reach the licensees and designees. CDSS emails updates often, so use an inbox you watch.

Item 6 — Street address

This is where CDSS will do unannounced inspections.

Item 8 — Designee

This is the person who directly runs the agency when the licensee is away. You can name more people on the HCS 308.

Item 9 — Business office hours

Enter the days and hours you are open to the public. CDSS will visit and inspect during this time. If you are "by appointment only," CDSS will still visit (HCS 281).

Item 10 — Property

Do you own or rent the office? If you rent, list the owner's name, address, and phone (item 10A).

Items 11 and 12 — Past and other licenses

Item 11 asks if this agency was licensed before. Item 12 asks for the name and number of any other care facility or HCO you run now.

Items 13 to 16 — Read before you sign
  • You agree to follow the law and to get CDSS approval before changes that affect your license.
  • Each person who needs fingerprints must be cleared before they have contact with clients or client records.
  • Item 15 is a promise "under penalty of perjury." The form has no notary section.
Corporations: Everyone who signs must be named in a Board Resolution. Send the Board Resolution with your packet (HCS 281).

Common Mistakes to Avoid

  • 1Putting a personal name as the applicant when an LLC or corporation is applying. The business is the applicant.
  • 2Listing hours when no one can open the office. CDSS visits during the hours you list.
  • 3Forgetting "County Where Signed" next to each signature.
  • 4Corporations: forgetting the Board Resolution that names who may sign.

Tips

  • Copy and paste your exact legal name. HCS 281 says your HCS 309 must match this form.
  • Work from home? Your home is your street address. If you rent it, list your 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

    Each signer adds a title, county where signed, and date. The form has no notary section (item 15 is a perjury statement).

  4. 4
    Corporations: attach a Board Resolution naming each person who signs

    HCS 281 A1. Skip this if you are not a corporation.

Information You Will Need

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

Applicant Name(s)

LLC or corporation? Use its exact legal name. Sole owner? Use your full legal name.

Required
Requested Action

Buying an agency? Pick "Sale" and write its HCO number (HCS 281).

Required
2F. If "Other," please specify
3 and 7. Mailing Address

HCS 281 does not say if a P.O. Box is OK here. Ask CDSS if you are not sure.

Application Filed By

Corporation? Send a Board Resolution naming who may sign (HCS 281).

Required
Home Care Organization Name
Required
Email Address
Required
3 and 5. Licensee / HCO Phone
Required
Home Care Organization Street Address

A real place, not a P.O. Box. Item 6 also asks for the county. The form header has a "County" box too. Check both after you print and fill by hand if blank.

Required
Designee of Home Care Organization

Often the owner. Use the same spelling as on the HCS 308.

Required
Designee Title

For example: Administrator, Managing Member, or CEO.

Required
Business Office Hours

List hours when someone can open the office for CDSS.

Required
Property Ownership
Required
10A. Property Owner Name (if renting)
10A. Property Owner Address
10A. Property Owner Phone
Was this Home Care Organization previously licensed?
Required
Do you run any other licensed care facility or HCO now?
Required
Facility / HCO Name

Only if you answered yes above.

Facility / HCO Number

The license number of that facility.

Other facility address (for your notes — not on the HCS 200)
Other facility type (for your notes — not on the HCS 200)
How many caregivers do you plan to start with? (for planning — not on the HCS 200)

The HCS 200 does not ask this. We use it to plan your next steps.

County Where Signed
Required

Documents Needed

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

Official Resources

Want us to handle this for you?

Our licensing team knows this form inside and out. We fill out every form, check every box, and submit the whole packet to CDSS on your behalf. You just answer a few simple questions.

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John Helmy

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John Helmy, Founder of HomeCareAtlas

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