CNA request for live scan service form

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Hey guys. I just wanted to ask if the info provided on the CDPH forms section for the CNA/HHA request for live scan service sample form was accurate. It only shows to check the "male or female" box, tick DOJ as level of service, and in the bottom it says

NOTE TO APPLICANT:

*Please input your Social Security Number (SSN) where required. The submission of your SSN will allow results to be transmitted from DOJ to CDPH accurately and timely. Failure to submit your SSN could cause delay in your certification

It doesn't say anything on the sample form about the contributing agency information or ORI code. Do i just follow what it says on the sample and fill in the application information? I'm a nursing student in California who recently finished fundamentals and wanted to test out for the CNA exam. Sorry if the answer is obvious or the question is stupid. This is the first time I had to fill out a live scan form and the sample info seems lacking. If anyone can help I'd appreciate it. Here's a link to the sample form.

http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/bcia8016sample.pdf

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