Get Application Appendix A Lara Sub 020 Form Lara Mi

Filling out the Application Appendix A Lara Sub 020 Form is essential for requesting a waiver of specific substance abuse licensing rules. This guide provides clear, step-by-step instructions to help you accurately complete the form online, ensuring a smooth submission process.

Follow the steps to successfully complete the form.

1. Click the ‘Get Form’ button to access the Application Appendix A Lara Sub 020 Form and open it in your editing tool.
2. In the 'Program License Number' section, provide the relevant license number assigned to your program.
3. For the first question, cite the specific rule number and description of the rule for which you are requesting a waiver.
4. In the next section, explain why compliance with this rule is not possible for your program. Be detailed and clear.
5. Describe how the waiver of this rule will impact the services provided to your clients.
6. Ensure that your program’s governing authority reviews and approves the waiver request. Attach the required documentation of their approval and note the date the governing authority approved the waiver request.
7. Indicate whether the approval of this waiver endangers the health, safety, or welfare of any clients or recipients of services. Respond with 'NO' or 'YES' and provide additional details if necessary.
8. State whether the approval of this waiver will place your program in non-compliance with any other local, state, or federal rules or regulations. Again, respond with 'NO' or 'YES' and provide specifics as needed.
9. Complete the Certification section by having the Program Director and the Governing Authority Representative Designee sign and date the form. Note that typed signatures are acceptable for electronic submission.
10. Once all sections are completed, save your changes, and proceed to download, print, or share the form as required.

Complete your documents online today for a seamless filing experience.