Get Ar Aas-9560 2009-2025

Filling out the AR AAS-9560, the provider application for the ElderChoices program, can be a straightforward process when approached systematically. This guide will provide clear and supportive instructions to assist users in completing the form accurately and efficiently.

Follow the steps to complete your AR AAS-9560 form online.

1. Click ‘Get Form’ button to obtain the form and open it in an editable format.
2. Begin by filling out the 'Provider Certification Information' section. Enter the name of your provider agency, and provide a contact telephone number, street address, city, state, zip code, and county. Make sure that all information is accurate and complete.
3. Identify the type of application being submitted. Mark the appropriate box for either 'Renewal,' 'Change,' or 'Application' as applicable.
4. In 'Section One - All Providers,' include the name of the agency contact person along with their title and direct telephone number. Ensure the principal officer of the agency signs the attached Provider Assurances.
5. For supporting documents, attach a list of the counties where services are provided, job descriptions for staff, a list of direct care staff with their criminal background check dates, proof of liability insurance, and in-service training session details.
6. If you are a provider of Adult Day Care or Adult Day Health Care, proceed to 'Section Two' and attach the current facility license issued by the relevant agency.
7. For home delivered meals, go to 'Section Three' and attach your current Food Establishment Permit.
8. Complete relevant sections for personal emergency response systems, homemaker providers, and chore providers as indicated in Sections Four to Six. Insert the necessary licenses and completed pre-certification questionnaires.
9. Review Sections Eight to Ten, ensuring that all necessary attachments and information are included for respite providers, adult family homes, and any required certification and verification statements.
10. Before finalizing, review the entire form for accuracy. Ensure the Principal Official's signature is included alongside their printed name, title, and date.
11. Once completed, save any changes made to the form and proceed to download, print, or share it as needed.

Complete your AR AAS-9560 form online and ensure all steps are followed for a successful submission.