Get Ca Hhsa Form Fcr 16 2015-2025

Completing the CA HHSA Form FCR 16 online is a crucial step for group home providers to report shelter costs and related self-dealing transactions accurately. This guide offers a detailed, user-friendly approach to ensure that all sections of the form are filled out correctly, helping to avoid any issues with rate setting.

Follow the steps to complete the CA HHSA Form FCR 16 online.

1. Press the ‘Get Form’ button to acquire the form. This will open the document in your preferred online editing tool.
2. Fill out the licensee/corporate name and program number. New providers should leave the program number section blank as instructed.
3. Provide your mailing address, email address, and the contact person's details, including their name and telephone number.
4. In section 1, enter the total number of licensed and pending facilities under your corporate name for the group home program.
5. In section 2, indicate the number of facilities owned by the corporation that have clear title or are under a mortgage/deed of trust.
6. For section 3, specify the number of facilities associated with your program that are under rental or lease agreements.
7. In section 4, answer yes or no to whether there are any additional shelter costs resulting from self-dealing transactions. If yes, describe these transactions.
8. Complete the certification section by signing the form as the president of the board or an authorized officer, also adding your title and date.
9. Once all sections are filled, save your changes. You may also download, print, or share the completed form as needed.

Complete your CA HHSA Form FCR 16 online today to facilitate the accurate assessment of your group home program.