Get Ccl 058 Request For Exception - Kansas Department Of Health ... - Kdheks

Completing the CCL 058 Request For Exception form is an essential step for obtaining necessary exceptions from regulations set by the Kansas Department of Health and Environment. This guide provides a structured approach to ensure your form is filled out correctly and submitted online effectively.

Follow the steps to successfully complete the form.

1. Click ‘Get Form’ button to obtain the CCL 058 Request For Exception form and open it for editing.
2. Select the type of facility you are requesting an exception for by marking the appropriate checkbox. Options include Attendant Care Center, CPA, Residential Center, and others.
3. In the space provided, indicate the specific regulation (K.A.R. #) from which you are seeking an exception. Clearly state the duration for which the exception is requested, including start and end dates.
4. Enter the current license capacity and the age range of children at your facility. This information is critical for understanding the context of your exception request.
5. Thoroughly explain your reason for the request. Address how the exception serves the best interest of the children, and describe your plans to ensure their health, safety, and well-being.
6. If you are requesting to exceed capacity, include the number, age, and gender of children to be placed, along with a floor plan of the facility indicating where they will be housed.
7. If the request pertains to extending the Length of Stay, provide specific details about the youth involved, the admission date, and the reasons for needing to exceed the established limits.
8. Provide the facility name, address, license number, and contact information in the designated fields to ensure proper identification.
9. Once all sections are completed, review the information for accuracy and completeness before submitting.
10. Finalize your submission by saving the changes, downloading, printing, or sharing the form as needed.

Complete your CCL 058 Request For Exception online today to ensure timely processing.