Get Nj Hcsf Form 1 2019-2025

Filling out the NJ HCSF Form 1 is an essential step for individuals seeking to obtain a health care service firm registration. This guide will provide clear and supportive instructions to help users complete the form accurately and efficiently online.

Follow the steps to successfully fill out the NJ HCSF Form 1 online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Provide the name of the business. Ensure that the name matches exactly with the name on your corporate, alternate name, and trade name documents, as well as the insurance certificate and any necessary bonds.
3. List any other names under which your business operates. If there are no other names, indicate ‘None.’
4. Select the type of business by checking the appropriate box: Sole Proprietorship, Partnership, Corporation, or Limited Liability Company.
5. Enter the street address and phone number for your primary business location. If there are multiple locations, note that a separate application is required for each.
6. Fill in the mailing address for the business. If it is the same as your primary location, write ‘N/A.’
7. Provide the name, business and home addresses, and phone number of your registered agent, if applicable.
8. Indicate your business’s net worth and attach the required insurance certificate and bond if necessary. If your net worth is below $100,000, submit the original surety bond.
9. Enter the Federal Employer Identification Number (FEIN) for your business.
10. Complete additional questions specifically for sole proprietorships if applicable.
11. List the full names, addresses, and percentages of ownership for every officer, director, and principal with a 10% ownership interest in the firm.
12. Ensure every relevant individual submits a signed and notarized affidavit confirming if they have ever been convicted of a crime.
13. Attach a copy of the New Jersey license of the Health Care Practitioner Supervisor employed by your agency.
14. Complete the form by reviewing all information for accuracy. Save changes, download, print, or share the form as needed.

Take the next step towards establishing your health care service firm by completing the NJ HCSF Form 1 online.