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  • Mi Bcal-1326a 2016

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AFC/HFA LICENSING RECORD CLEARANCE REQUEST Administrator Responsible Person or Adult Member of Household Only STATE OF MICHIGAN Department of Licensing and Regulatory Affairs Bureau of Communit and Health S stems DIRECTIONS FOR COMPLETING FORM Type or print CLEARLY so that the information provided can be read. Mail the completed form to the Bureau of Community and Health Systems BCHS at the address below. Michigan Department of Licensing and Regulatory Affairs P O Box 30664 Lansing MI 48909 Licensin Consultant if known REQUESTOR INFORMATION LICENSEE/APPLICANT NAME NAME OF FACILITY COUNTY LICENSE NUMBER AFC Group Home AFC Family Home THE PERSON BEING CLEARED IS CHECK ONLY ONE BOX Note Administrators or Responsible Persons are to be cleared through the Workforce Background Check Program. Website https //miltcpartnership.org/ Responsible Person Adult Member of Household CLEARANCE INFORMATION PRINT CLEARLY NAME Last First Middle Jr. Michigan Department of Licensing and Regulatory Affairs P....

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You must file an application with the state, which will review the application and provide a license if you satisfy all criteria for your type of adult foster care home. The state wants to determine whether you can handle emergencies and whether you have the appropriate temperament to care for the elderly.

What is a Child Care Background Check? A child care background check is a both a fingerprint-based and name-based check that will cover the following: Michigan State Police (MSP) fingerprint-based check of criminal history. Federal Bureau of Investigation (FBI) fingerprint-based check of criminal history.

Adult Foster Care (AFC) homes are licensed residential settings that provide 24-hour personal care, protection, and supervision for individuals who are developmentally disabled, mentally ill, physically handicapped or aged who cannot live alone but who do not need continuous nursing care.

Special Note: The State of Michigan does not license assisted or independent living facilities. Please note, however, that a Home for the Aged or Adult Foster Care Home license may be required if the level of care provided at the facility meets the licensing requirements of one of these license types.

Pricing by room type Room typesAverage monthly costShared Suite$3,324Private Suite$3,988

A Licensing Information Request form will need to be completed and submitted for members of the household (18 years of age or older, who live in the home and are not foster care residents) and all responsible persons. If additional forms are needed, please contact the Licensing Unit at 1-866-856-0126.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232