Get In 53391 2012-2026
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How to fill out the IN 53391 online
Filling out the IN 53391 form, which is the application for a license to operate a personal services agency, is an essential step for any agency seeking to provide personal services in Indiana. This guide will provide clear and detailed instructions on how to navigate and complete this form online.
Follow the steps to complete your application successfully.
- Press the ‘Get Form’ button to access the form and open it in your preferred application or editor.
- Begin by checking the appropriate box in Section I to indicate the type of application you are submitting (e.g., New Agency, Change of Ownership). If applicable, provide the anticipated date of sale or purchase.
- In Section II, provide identifying information about your agency, including the agency name, address, and contact information. Ensure this matches the documentation from the Indiana Secretary of State.
- Specify your agency’s office hours in Section II-B. List the open hours for each day of the week as required.
- If your mailing address is different from the practice location, complete Section II-C with the correct mailing address.
- In Section II-D, provide the legal entity name associated with your agency. Include all required documentation from the Secretary of State and the IRS.
- If applicable, indicate whether you are applying for a branch office in Section II-E and provide the necessary details if you are.
- Section III requires you to submit criminal history checks for key staff. Fill out the sections for each manager and alternate manager, providing their personal details.
- In Section IV, declare the ownership information, including the names and addresses of individuals or entities with controlling interest. Complete any applicable agreements related to ownership changes.
- Section V is where you certify your application. Ensure all information is accurate, sign the application where indicated, and record the dates.
- Finally, gather all required policies and documentation and review the instructions in Section VI for submission. Pay the non-refundable fee of $250.00 to the Indiana State Department of Health.
Start filling out your IN 53391 form online today to ensure you comply with Indiana regulations.
Becoming a private home care provider in Indiana involves several steps. First, complete any necessary training or certifications required by the state. Then, you should register your business and acquire the needed licenses. Consider utilizing resources like US Legal Forms to help manage your documentation and ensure you meet the legal requirements, especially in the IN 53391 area.
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