We use cookies to improve security, personalize the user experience, enhance our marketing activities (including cooperating with our marketing partners) and for other business use.
Click "here" to read our Cookie Policy. By clicking "Accept" you agree to the use of cookies. Read less
Read more
Accept
Loading
Form preview
  • US Legal Forms
  • Form Library
  • More Forms
  • More Uncategorized Forms
  • Flis Licapp 001 Form

Get Flis Licapp 001 Form

O. Box 340308 Hartford CT 06134 An Equal Opportunity Employer FLIS LICAPP 001 Rev. 3-06 Page 2 of 4 Bed Capacity Requested if applicable.

How it works

  1. Open form

    Open form follow the instructions

  2. Easily sign form

    Easily sign the form with your finger

  3. Share form

    Send filled & signed form or save

How to fill out the Flis Licapp 001 form online

The Flis Licapp 001 form is a critical document for applying for a facility license in Connecticut. This guide provides clear, step-by-step instructions on how to complete the form online, ensuring users have the necessary information to fill out each section accurately.

Follow the steps to successfully complete the Flis Licapp 001 form online.

  1. Click the ‘Get Form’ button to obtain the form and open it for editing.
  2. Select whether you are submitting an initial application or a renewal application by checking the appropriate box at the top of the form.
  3. Indicate the type of facility you are applying for by checking the relevant boxes; ensure that you list all applicable levels of care.
  4. Fill in the facility 'doing business as' (d/b/a) name, business address, and contact information in the specified fields.
  5. Complete the bed capacity requested for each level of care if applicable, including bassinets and hemodialysis stations.
  6. Provide the Federal Employer Identification Number in the designated field.
  7. Enter the legal entity that owns and operates the facility, along with its address and contact details.
  8. Check the appropriate box corresponding to the type of legal entity that owns the facility.
  9. Indicate whether the entity is in good standing with the Office of the Secretary of State.
  10. Complete the information of the Agent for Service for the Licensee.
  11. Attach necessary documents such as an organizational chart, insurance certificates, and compliance evidence as outlined by the form.
  12. Review all completed sections for accuracy to avoid any application delays.
  13. Once satisfied with the application, save changes, then proceed to download, print, or share the form as needed.

Complete your Flis Licapp 001 form online to ensure a smooth application process.

Get form

Experience a faster way to fill out and sign forms on the web. Access the most extensive library of templates available.
Get form

Related content

Facility Licensing Investigations Section FLIS...
Facility Licensing & Investigations Section (FLIS). Page 1 of 1 ... State of CT FDA...
Learn more

Related links form

Process A Financial Sale Transaction - Asean Consent Form Driving Licence Check - Backlinelogistics Co Unit 4 Test Linear Relations Practice Test Course: MPM 1D0 Unit 4 Test: Linear Relations ... - Misternolfi.com

Questions & Answers

Get answers to your most pressing questions about US Legal Forms API.

Contact support

If you have a complaint against a licensed professional you can file a complaint online or by calling 1.800. 382.5516 or 317.232. 6330.

A person wishing to file a complaint should contact an intake officer at one of the Commission's regional offices. The intake worker will discuss your concerns, explain our complaint process and advise you about what help CHRO may be able to provide to you.

The toll free number is: (800) 828-9769.

860-707-1916.

The toll free number is: (800) 828-9769.

NURSING HOME INFORMATION You can contact the Department of Public Health complaint phone line by dialing: (860) 509-7400 or you can find additional information via the DPH website, Reporting a Complaint. 1-866-388-1888.

Get This Form Now!

Use professional pre-built templates to fill in and sign documents online faster. Get access to thousands of forms.
Get form
If you believe that this page should be taken down, please follow our DMCA take down processhere.

Industry-leading security and compliance

US Legal Forms protects your data by complying with industry-specific security standards.
  • In businnes since 1997
    25+ years providing professional legal documents.
  • Accredited business
    Guarantees that a business meets BBB accreditation standards in the US and Canada.
  • Secured by Braintree
    Validated Level 1 PCI DSS compliant payment gateway that accepts most major credit and debit card brands from across the globe.
Get Flis Licapp 001 Form
Get form
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232