Form Rfa 09b - Notice Of Action To Individual Regarding Resource Family Approval Criminal Record Exemption Decision

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County:
Date:
Applicant(s) or RF Name(s):
County RF ID#:
RF Address:
Individual’s Name:
PER ID#:
To:
[Insert individual's address]
Notice of Action to Individual
Regarding Resource Family Approval
Criminal Record Exemption Decision
This notice is to inform you that
on
has been
A denied or rescinded exemption means that you
may not reside or be regularly present in an approved Resource Family home, and you may not
have contact with children or nonminor dependents placed in the home, until you obtain a criminal
record exemption. If you applied for Resource Family approval, this means your application must be
denied. If you are currently approved as a Resource Family, this means the approval will be referred
for rescission.
This
of a criminal record exemption is based upon your failure to provide satisfactory
evidence that you can meet or conform to all Resource Family Approval background check
requirements as set forth in Welfare and Institutions Code Section 16519.5 et seq., other applicable
law and RFA Written Directives, Version
sections 6-03A, 6-03B, and 10-01.
Specifically, it has been determined that you:
[Check one only.]
Have a criminal conviction or convictions for which you have failed to provide substantial
and convincing evidence that you are rehabilitated and of present good character .
Have a non-exemptible criminal conviction or convictions for which we are prohibited by law
from granting a criminal record exemption.
RFA 09B (1/18)
Page ____ of ____

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