Get Dphhs Qadcrl 060 Form

The Dphhs Qadcrl 060 Form is essential for submitting a license application or renewal request for community homes serving persons with developmental or physical disabilities. This guide offers clear, step-by-step instructions to help you complete the form online with ease.

Follow the steps to successfully complete the Dphhs Qadcrl 060 Form online.

1. Press the ‘Get Form’ button to access the Dphhs Qadcrl 060 Form and open it in your preferred online editor.
2. Begin by filling in the name of the corporation in the designated field.
3. Input the name of the community home in the corresponding section.
4. Provide the mailing address for the corporation, ensuring all fields are accurately completed.
5. Enter the community home address in the relevant area.
6. Specify the city/town, state, and zip code for both the corporation and the community home addresses.
7. Fill in the corporation telephone number for contact purposes.
8. Specify the name of the executive director in the designated section.
9. Input the name of the community home manager in their respective field and provide the community home telephone number.
10. Indicate whether the application is for a community home for persons with developmental disabilities or physical disabilities by checking the appropriate box.
11. Check the box next to items that are enclosed with the application or write in the date when items will be sent to the department.
12. Document the date for new applicants or renewal applicants as applicable.
13. List any requested inspections, such as the fire marshal and sanitarium inspections, along with dates obtained or requests made.
14. Include any necessary documentation such as articles of incorporation, bylaws, or details about major changes to important organizational elements.
15. Outline the board structure and composition with relevant names, addresses, and terms.
16. Detail the plan for orientation and training of staff.
17. Review the completed form for accuracy and completeness.
18. Once finished, save your changes, download, print, or share the form as necessary.

Complete your Dphhs Qadcrl 060 Form online today!