Get Homebound Service Permit Application - Mn.gov

Filing for a Homebound Service Permit can be straightforward if you follow the right steps. This guide provides clear instructions to help you successfully complete and submit the Homebound Service Permit Application online.

Follow the steps to fill out the application accurately.

1. Press the ‘Get Form’ button to access the Homebound Service Permit Application. This will allow you to open the form in your preferred online editor.
2. Begin by filling out the Applicant Information section. Enter your first name, last name, street address, city, state, zip code, phone number, email address, license number, and expiration date. Ensure that the information is accurate to avoid any processing delays.
3. Proceed to the Insurance Information section. Provide the name of your insurance company and the name of your insurance agent. Include the professional liability policy number as well as the agent's phone number and/or email address.
4. Attach a Certificate of Professional Liability Insurance. This certificate must verify your full legal name as the policyholder, state that you have a professional liability policy, confirm it is current, and meet the coverage requirements. Make sure this document is included before submission to prevent application return.
5. Review the HSP Acknowledgments section. Carefully read each acknowledgment (A through H) and initial accordingly. It is crucial to confirm your understanding and compliance with the rules set forth.
6. Complete the Application Certification section by signing and dating the application. This certifies that your information is accurate and that you have not altered the document in any way.
7. Finally, save your completed application. You may choose to download, print, or share the form as necessary. Be sure to submit your completed application along with the $50 fee, either by mail or in person to the indicated address.

Complete your Homebound Service Permit Application online today to ensure timely processing of your permit.