Get Request For Exception

This guide provides clear and supportive instructions for completing the Request For Exception form online. Following these steps will ensure you properly fill out the form and understand its components.

Follow the steps to complete the form accurately

1. Click the ‘Get Form’ button to obtain the Request For Exception form and access it for editing.
2. Fill out the 'Name – Facility' field by entering the official name of your facility.
3. Enter the 'Facility ID Number' that identifies your facility for licensing purposes.
4. Provide the 'Address – Facility' by including the street address, city, state, and zip code.
5. Indicate the 'County in Which Facility is Located' for accurate geographical identification.
6. List the 'Applicable Rule Number(s)' for which you are requesting an exception, detailing any specific rules you wish to address.
7. In 'Existing Situation – Specify', describe the current circumstances that justify your exception request.
8. Outline your 'alternative plan to meet the intent of the rule(s)' that you are requesting an exception for.
9. Complete the 'Provide dates of proposed exception' section by filling out the start date and end date fields, ensuring that the end date is not later than your next license continuation date.
10. Type or print your name in the 'Name – Licensee' field and specify your position in the 'Licensee Title / Position'.
11. Sign the form in the 'SIGNATURE – Licensee' field, and enter the 'Date Signed' in the specified format.
12. If you require additional space, attach separate sheets as necessary.
13. Upon completion, review the form for accuracy, save your changes, and submit it for approval. You may download, print, or share the form as needed.

Start filling out your Request For Exception online today.