Follow the steps to successfully complete your application

1. Press the ‘Get Form’ button to access the form and open it in the editor.
2. Begin by selecting the appropriate application type, either 'Initial Application Fee' or 'Renewal Application Fee.' Make sure to include the applicable fee as indicated on the form.
3. Enter the 'Facility License ID' and the 'Name of Facility, Center, or Home' in the designated fields.
4. Fill in the 'Street Address,' 'City,' and 'Zip Code' of the facility to ensure accurate identification.
5. In Section A, indicate whether the facility has made diligent efforts to recruit and retain certified nurse aides by selecting 'Yes' or 'No.' If 'Yes,' attach relevant documentation that proves efforts taken.
6. Proceed to Section B, answering whether an OSDH inspection or investigation has been conducted since July 11, 2005. Depending on your answer, follow the subsequent instructions accordingly.
7. If you answered 'Yes' to Section B, address Items C and D regarding any deficiencies or violations cited by OSDH. Record any necessary details including dates of correction for each item.
8. In Section E, estimate the number of persons expected to be employed during the waiver's effectiveness, detailing numbers for Certified Nurse Aides, Uncertified Nurse Aides, and Other Direct Care Staff.
9. Provide explanations in Sections F and G regarding your inability to meet staffing requirements and how uncertified nurse aides will be utilized during the waiver period.
10. Complete the form by typing or printing your name, phone number, email, and signing the document in the designated area.
11. Finally, review the application for completeness, save your changes, and download or print the form for submission to the specified address along with the application fee.

Complete your online application for the OK ODH 297 today to ensure compliance with staffing requirements.