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CA Optometry 39M-11 2012-2025 free printable template

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STATE AND CONSUMER SERVICES AGENCY GOVERNOR EDMUND G. BROWN JR. STATE BOARD OF OPTOMETRY 2450 DEL PASS ROAD, SUITE 105, SACRAMENTO, CA 95834 P (916) 575-7170 F (916) 575-7292 www.optometry.ca.gov
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Obtain a copy of CA Optometry 39M-11 form.
02
Fill in your personal information including name, address, and license number.
03
Indicate the purpose for which you are submitting the form.
04
Provide any additional required information, such as details of your practice.
05
Review the completed form for accuracy.
06
Sign and date the form.
07
Submit the form to the appropriate state authority, either online or by mail.

Who needs CA Optometry 39M-11?

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Optometrists practicing in California who need to report certain information or apply for specific permits or licenses.
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You can complete and submit your AR-11 form online or through your USCIS account. If you are a victim of domestic violence, trafficking, or have previously filed a Form I-751 abuse waiver, you may submit yourAR-11 Form as a paper copy via mail.
What information is required to file the AR-11? The Form AR-11 requests the Alien's name, Alien Registration number (“A-Number”), current/new address, and previous/old address.
By Phone: U.S. citizens can let USCIS know about a change in address by calling them at 1-800-375-5283. (Non-citizens are still required to file form AR-11 or an online notification, even if they've told USCIS by phone about an address change).
If you are a victim of domestic violence, trafficking, or other crime, or if you previously filed a Form I-751 abuse waiver, you must submit a paper Form AR-11.
Filing Form AR-11 online will update your address on all pending applications, petitions, or requests that you include on the form. You do not need to mail Form AR-11 if you use the change of address webpage.
The completed form can be mailed to Secretary of State, Document Filing Support Unit, 1500 11th Street, 3rd Floor, Sacramento, CA 95814 or delivered in person to the Sacramento office. If you are not completing this form online, please type or legibly print in black or blue ink.
The Statement of Information LLC (SOI) is known as Form LLC-12 in California. The SOI acts as an annual report form that must be submitted to the California Secretary of State every two years. Note that other states refer to this as a Biennial Report or Annual Report.
When is the California Statement of Information due? Your filing due date will be the last day of your anniversary month. So, if you formed your business on June 14, then your filing date will be June 30 each year OR June 30 every other year – depending on what type of entity you own.
ing to California state law, all California corporations, nonprofits, and LLCs must file a California Statement of Information – also called an annual report. These statements must be filed with the California Secretary of State each year OR every other year – depending on what type of business you own.

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CA Optometry 39M-11 is a form used by optometrists in California to report their professional activities and financial information to the state licensing board.
Licensed optometrists in California are required to file the CA Optometry 39M-11 form as part of their regulatory compliance.
To fill out CA Optometry 39M-11, optometrists need to provide their personal information, practice address, and details regarding their professional activities, ensuring all sections are completed accurately.
The purpose of CA Optometry 39M-11 is to collect data for monitoring compliance with state laws and regulations related to optometric practice, and to ensure public health and safety.
The information that must be reported on CA Optometry 39M-11 includes the optometrist's identification details, practice statistics, patient care data, and any adverse incidents in the practice.
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