Get Pw 633 Application For Certificate Of Compliance In Pa

The Pw 633 Application For Certificate Of Compliance is a crucial document for agencies and facilities seeking compliance certification in Pennsylvania. This guide provides step-by-step instructions to help you navigate the online application process easily.

Follow the steps to complete the application efficiently.

1. Click 'Get Form' button to access the application and open it in the editor.
2. Fill out the 'Name and Address of Agency/Facility' section. Provide the complete name and physical address of the agency or facility, along with an email address and phone number if available.
3. Complete the 'Name and Address of Legal Entity' section. Indicate the name of the legal body responsible for the operation and provide the relevant contact information.
4. In the 'County and Municipality' section, select the county and specify the municipality, township, or borough where the facility is located.
5. Identify the 'Responsible Person' by providing their name and title. This person is accountable for the daily operations of the facility.
6. Select the 'Type of Agency/Facility Service.' Choose the type of service that best describes the agency or facility's operations from the provided options.
7. If applicable, specify the 'Requested/Licensed Capacity' for personal care homes and assisted living residences.
8. Insert the 'Federal Employer Identification Number' or the 'Social Security Number' of the legal entity. Remember that providing a Social Security Number is optional.
9. Indicate whether the operation is 'Profit' or 'Non-Profit' by checking the appropriate box.
10. Detail the 'Type of Ownership/Control' by selecting the relevant category that describes the ownership structure of the legal entity.
11. Respond to the inquiries regarding prior license statuses by selecting 'Yes' or 'No' and providing explanations for any affirmative responses on a separate sheet if necessary.
12. Attach any required documentation specified in the 'Attachments' section, such as the Certificate of Occupancy and articles of incorporation, if applicable.
13. Complete the 'Declaration' section by signing and dating the application. Ensure the signature is from a person authorized to represent the legal entity.
14. After filling out the form, review all the information for accuracy. Save your changes, and use the options to download, print, or share the completed application.

Start your application today and ensure compliance by completing the Pw 633 form online.