Get License Application - Kdads Provider Information Resource Website - Aging Ks

Completing the License Application for the KDADS Provider Information Resource Website can feel daunting. This guide provides a thorough, step-by-step approach to help users navigate the application with confidence and clarity.

Follow the steps to successfully complete your application.

1. Press the ‘Get Form’ button to access the application. This will allow you to open the form in your chosen editor.
2. Begin by entering the legal name of your organization in the 'I/DD Service Provider' field. Ensure that the name matches your official records.
3. Fill in the agency mailing address. Include the city, state (KS), and zip code to ensure accurate correspondence.
4. Provide your Federal ID Number or Employer Identification Number (EIN) in the designated field.
5. Indicate the requested effective start date for your services. It is advisable to submit your application at least 60 days before this date.
6. Complete the section for the Director, Administrator, CEO, or President's name and their contact phone number.
7. If applicable, provide the email address and website address for your agency. Include a fax number as well if you have one.
8. List the principal affiliating Community Developmental Disability Organization (CDDO) primary service area.
9. If your agency is affiliated with any other CDDO, provide that information in the fields available.
10. For the Board Chair, if applicable, fill in their mailing address, phone number, and fax number.
11. Detail all locations where services will be provided. Include the physical addresses, phone numbers, and capacity to serve for each location. You may add additional pages if necessary.
12. In the certifications section, agree to abide by all relevant laws and KDADS regulations by checking the provided agreements and ensuring full understanding of the stipulations outlined.
13. As the authorized agent of the applicant, sign and date the application to certify that you have read and understood the governing laws.
14. Finally, submit your completed application to the KDADS Community Services and Programs at the designated address either by mail, fax, or email. Make sure to keep a copy for your records.

Complete your application online today to ensure timely processing and compliance.