
INFORMATION COLLECTION, ACCESS AND DISCLOSURE
*This statement is for your information.
The Information Practices Act, Sec. 1798.17 Civil Code, requires the following information to be provided when
collecting information from individuals.
AGENCY NAME:
Board of Barbering and Cosmetology
TITLE OF OFFICIAL RESPONSIBLE FOR INFORMATION MAINTENANCE:
Executive Officer
ADDRESS:
2420 Del Paso Road, Suite 100, Sacramento, CA 95834
INTERNET ADDRESS:
www.barbercosmo.ca.gov
TELEPHONE AND FAX NUMBERS:
(916) 574-7570 phone (916) 575-7281
AUTHORITY WHICH AUTHORIZES THE MAINTENANCE OF THE INFORMATION:
Sections 7300 to 7457, inclusive, comprising Chapter 10 Division 3, of the California Business and Professions Code.
CONSEQUENCES OF NOT PROVIDING ALL OR ANY PART OF THE REQUESTED INFORMATION:
It is mandatory that you provide all information requested. Omission of any item of requested information will result in
the application being rejected as incomplete.
PRINCIPAL PURPOSE(S) FOR WHICH THE INFORMATION IS TO BE USED:
The information requested will be used to determine qualifications for licensure or certification to determine compliance
with the group and corporate practice provisions of the law and to establish positive identification.
ANY KNOWN OR FORESEEABLE DISCLOSURES WHICH MAY BE MADE OF THE INFORMATION:
Your completed application becomes the property of the board and will be used by authorized personnel to determine
your eligibility for a license or certification. Information on your application may be transferred to other governmental or
law enforcement agencies. Pursuant to the California Public Records Act (Gov. Code Section 6250 et seq.) and the
Information Practices Act (Civ. Code Section 1798.61), the names and addresses of persons possessing a license or
registration may be disclosed by the department unless otherwise specifically exempt from disclosure under the law.
Consequently, the personal name and address information entered on the attached form(s) may become public
information subject to disclosure
SOCIAL SECURITY NUMBER (SSN) DISCLOSURE:
Disclosure of your social security number is mandatory. Section 30 of the Business and Professions Code and Public
Law 94-455 [42 U.S.C.A. Section 405(c)(2)(C)] authorize collection of your social security number. Your social security
number will be used exclusively for tax enforcement purposes, for purposes of compliance with any judgment or order
for family support in accordance with section 17520 of the Family Code, or for verification of licensure or examination
and where licensure is reciprocal with the requesting state. If you fail to disclose your social security number, you will be
reported to the Franchise Tax Board, which may assess a $100 penalty against you.