Get Lic 9106a

The Lic 9106a is a crucial document for the short-term residential therapeutic program, guiding the establishment and operation of facilities. This guide will provide clear, step-by-step instructions to assist users in accurately completing the form online.

Follow the steps to fill out the Lic 9106a correctly.

1. Click the ‘Get Form’ button to access the Lic 9106a document and open it in your preferred online editor.
2. Begin by entering the facility name and facility number at the top of the form. Ensure this information matches the official registration documents.
3. Input the date received and all relevant reviewer details. This section is crucial for tracking the submission and review process.
4. Fill in the required contact details of the regional office, including the name and title of the contact person and their telephone number.
5. Complete the 'Applicant/Licensee Name' section with the legal entity’s name responsible for the facility.
6. In the section for licensing requirements, indicate compliance with each requirement by checking the appropriate boxes for policies submitted, educational letters sent, and other relevant details.
7. For the 'Plan of Operation,' ensure that you fully address each subsections, detailing your facility's vision, mission, and goals, along with the administrative organization structure.
8. Continue filling out the form by detailing procedures regarding child abuse reporting, admission policies, and emergency intervention plans as required in each distinct section.
9. Conclude by reviewing your entries carefully to ensure accuracy. Save the form in your desired format, whether for digital storage, printing, or sharing as required.

Start completing your Lic 9106a online today for a seamless application process.