Get Ca Cdph 512 2014-2025

The CA CDPH 512 is an essential form for nursing home administrators in California seeking to renew their licenses. This guide will provide you with clear, step-by-step instructions on how to complete the form online, ensuring that you understand each component and its purpose.

Follow the steps to successfully complete the CA CDPH 512 online.

1. Click the ‘Get Form’ button to access the CA CDPH 512 and open it for completion.
2. Begin by entering your NHA license number in the designated field. This number is crucial for identifying your application.
3. Indicate your license status by selecting either 'Active' or 'Inactive'. If your license has expired for more than two years, contact the NHAP office for renewal information.
4. Fill in the administrator's name with your last, first, and middle initials. Accuracy is important for identification purposes.
5. Provide your email address and mailing address, including the street name, city, state, and zip code. Make sure these details are current to receive important notifications.
6. Enter your telephone number for additional contact. This will help in clarifying any issues that may arise during the processing of your application.
7. In the social security number section, input your information as it is mandatory for processing your application. Understand that it is required for various legal purposes.
8. Complete the continuing education section by indicating whether you have completed the required 40 hours of continuing education. Select the appropriate statement regarding your license status.
9. In the family support section, select one of the options related to your compliance with child or family support orders. It is essential to be truthful in this declaration.
10. For the conviction disclosure, indicate whether you have had any legal convictions since your last renewal. This includes all misdemeanors and felonies.
11. If there have been changes to your name or address, provide the corrected details in the respective fields, and attach documentation to verify these changes.
12. Finally, read the certification statement thoroughly before signing and dating the application. Your signature confirms that the information provided is accurate and complete.
13. Once all sections are completed, you can save your changes. Then, you can download, print, or share the form as necessary to ensure proper submission.

Start filling out the CA CDPH 512 online today to ensure a smooth renewal process.