Get Mn Dhs Substance Use Disorder License Application 2018-2026

The Minnesota Department of Human Services (DHS) provides a Substance Use Disorder License Application for organizations and individuals seeking to offer treatment services. This comprehensive guide outlines the steps necessary to complete this application online, ensuring that you understand each component and can navigate the process with confidence.

Follow the steps to successfully complete your application.

1. Press the 'Get Form' button to access the MN DHS Substance Use Disorder License Application form in the editor.
2. Fill in the program name and physical location. This includes the name, address, and a contact number of the program.
3. Provide the license holder's contact information. This will either be the complete name of the organization registered with the Secretary of State or the legal names of individual license holders.
4. Select your type of business structure from the given options: nonprofit, corporation, partnership, etc.
5. Indicate the type of substance use disorder program you plan to operate, selecting all applicable categories.
6. Complete the program site information section by specifying the ages and genders of the clients you intend to serve.
7. Enter the maximum number of clients your program will serve as the requested license capacity.
8. List all controlling individuals associated with your program, providing their contact details. If there are more individuals than space allows, you may attach an additional page.
9. Enter contact information for the authorized agent, ensuring they are among the controlling individuals listed.
10. Indicate whether you currently hold any other DHS licenses and provide relevant license numbers if applicable.
11. Enter your MN tax ID or Social Security Number based on whether you are applying as an organization or an individual, and also include your Federal Employer Identification Number (FEIN).
12. Decide whether you wish to receive public funding and acknowledge the associated compliance requirements.
13. Review and check each item in the License Application Agreement, confirming your understanding and compliance with the necessary conditions.
14. Prepare and submit the additional required documents which include a written manual of policies and procedures among others.
15. Be aware that some documents will need to be provided at a later date for enhanced rate services, as specified during the application process.
16. Check the attached privacy notice before proceeding to finalize your application.
17. Submit the completed application form, alongside all required documents and the $500 application fee, to the specified DHS PO Box.
18. Keep a copy of all completed forms and materials for your records once you submit the application.

Complete your MN DHS Substance Use Disorder License Application online today to begin providing critical treatment services.