Get 290 4 207 Form

The 290 4 207 Form is essential for obtaining a license to operate a drug abuse treatment and education program. This guide will walk you through each section of the form, helping you to complete it accurately and efficiently, ensuring compliance with regulations.

Follow the steps to correctly fill out the 290 4 207 Form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Complete Section A: Identification. Here, you will select the type of application (Initial, Renewal, Update/Change), provide the official name of the program, and fill in the program's address and phone number.
3. In Section B: Ownership Information, check the type of ownership of the program, and list the names and addresses of all owners with five percent or more interest.
4. Move to Section C: Program Modalities Provided and check all types of programs located at your address. Specify the capacity for residential programs and populations served.
5. In Section D: Personnel, indicate the number of staff members assigned to the program, including counselors, registered nurses, and administrative personnel, with their hours scheduled weekly.
6. Next, fill out Section E: Program Information, detailing the drug treatment and education services provided at this location, along with any other related services.
7. For Section F: Required Attachments, prepare all necessary documents such as the comprehensive program outline, proof of compliance with laws, and the affidavit of lawful presence.
8. Finally, complete Section G: Certification by providing the signature, date, and printed name of the principal officer or authorized representative, ensuring that all information is accurate.
9. Once completed, save your changes in the online editor, then download, print, or share the form as needed.

Ensure that your application for a license is complete and submit it online today.