Get Ambulence Online Form 206

Filling out the Ambulence Online Form 206 is a crucial step in securing an EMS operating certificate for your ambulance service. This guide will provide you with clear, step-by-step instructions to ensure a smooth completion of the form online.

Follow the steps to successfully complete your application.

1. Click ‘Get Form’ button to obtain the form and open it in your editor.
2. Begin by entering the name of your ambulance service in the designated 'Name of Service' field. Ensure accuracy to avoid issues later in the application process.
3. Input your Federal Employer ID Number and the New York State EMS Agency Code. These identifiers are important for verifying your organization.
4. Provide the physical address of your principal business location, including street number, city, state, zip code, and county. This ensures that official communications reach your organization.
5. Complete the mailing address if different from the physical address. Include any P.O. Box details, as well as the business phone number and agency e-mail address for correspondence.
6. Specify the 911 Center 10-digit phone number, as this is crucial for communication in emergencies.
7. Select the appropriate organizational structure by checking only one option (e.g., Commercial, Hospital Based, Independent). This classification will affect your application process.
8. Indicate the type of ownership of your organization, selecting from options such as Individual, Partnership, or Corporation.
9. If applicable, provide the name of the individual owner, partners, or government entity. If your organization is a corporation, indicate the official corporate name and any assumed names (DBA) filed.
10. List the names and addresses of current corporate officers including the President, Vice President, Secretary, Treasurer, and Chief Operating Officer.
11. Answer the question regarding whether your organization is funded by a tax district. Provide details if applicable.
12. Fill in the name of the operator if it differs from the owner, along with their address and phone information.
13. Select the highest level of care authorized by REMAC by checking the appropriate box (e.g., EMT, AEMT, Paramedic).
14. Specify whether your agency participates in a Continuing Medical Education program and the name of your service bureau if billing for service.
15. List and provide the address for each location where certified EMS response vehicles are garaged if different from the principal location. Include the number of vehicles assigned to each location.
16. Complete the total number of vehicles operated by the certificate holder, including ambulances and first response units.
17. Detail the total employees and members, breaking them down into paid and volunteer categories.
18. Provide the number of individuals currently certified at each level (CFR, EMT, AEMT, Critical Care, Paramedic).
19. Indicate the principal dispatch method and the agency that dispatches your service. Identify your radio systems for calling and medical direction.
20. Affirm that you have reviewed and will comply with the associated laws and documents outlined in the application.
21. Finally, certify that all information is accurate, sign where required, and include the date of application. This assures the validating authorities of your commitment to honesty.

Begin the process of completing your Ambulence Online Form 206 online today!