Get Request For Change In Resident Capacity Form - Aging Ks

Filling out the Request For Change In Resident Capacity Form is an essential step for institutions seeking to modify their certified bed capacity. This guide provides a clear and detailed walkthrough of each section, ensuring that users can complete the form accurately and efficiently online.

Follow the steps to successfully complete the form online.

1. Press the ‘Get Form’ button to retrieve the Request For Change In Resident Capacity Form - Aging Ks. This will allow you to open the document in your preferred editor for completion.
2. Begin by filling out the facility information, which includes the facility name, address, phone number, fax number, email address, CMS certification number, and state ID. Ensure all details are accurate as they are crucial for processing your request.
3. In section I, indicate the requested action for licensed beds by selecting whether you are requesting an increase or decrease in licensed bed capacity. Clearly specify the current and proposed numbers and provide the new licensed bed count for each facility type.
4. For any changes in bed capacity, include the required payment within section II. Choose your payment method from the options of credit card, check, or money order, and specify the amount due as relevant.
5. In section III, if applicable, prepare to submit floor plans that detail the current and proposed bed configurations. Include room numbers and the number of beds per room to meet compliance requirements.
6. If your request affects the use of any required rooms or areas as stated in section IV, ensure you complete the ‘Request for Change in Use of Required Room’ form in line with the regulations.
7. Finally, print your name, sign, and date the form to certify that all provided information is correct. Review all entries for accuracy before submission.
8. Once completed, submit the form along with the required payment to the Kansas Department on Aging at the specified address, ensuring to keep copies for your records.

Complete your Request For Change In Resident Capacity Form online today to ensure a smooth submission process.