Follow the steps to complete your registration efficiently.

1. Click ‘Get Form’ button to access the registration form and open it for editing.
2. Begin with section A, where you will provide your agency's identification details, including the agency name, street address (note that a P.O. Box alone is not acceptable), city, state, zip code, telephone number, hours of operation, email address, after hours number, and fax number.
3. In section B, indicate the type of ownership by filling in the corresponding code. You must also provide the name of the individual or entity legally responsible for the operation of the agency, along with federal and state tax identification numbers.
4. Complete section C if you have a management agent who is different from the owner, providing their name and address.
5. For section D, attach names and addresses of all officers and members of the governing body, or check the box if this section is not applicable.
6. Move to section E to verify employee licensing and education by signing in the designated area, confirming compliance with the minimum standards as mentioned in Minnesota Statute §144A.72.
7. If this is a renewal application (section F), specify if you have provided supplemental nursing services to any health care facility in the past 12 months and detail the last date of service and the name of the facility.
8. In section G, provide specific information about the services offered by your agency, including the types of care and the total number of employees categorized by their specialties.
9. For section H, include your signature as the authorized representative, along with confirming the enclosed annual registration fee of $2,035.00.
10. Ensure you have attached all required documents as outlined at the end of the form before concluding.
11. Once all fields are completed and documents attached, save your changes. You can download, print, or share the form as needed.

Complete your Snsa Minnesota registration online today!