Get Mn Doh Hcalp-f0070 2021-2025

This guide provides a comprehensive overview of how to accurately fill out the MN DOH HCALP-F0070 form for home care licensure. With clear step-by-step instructions, you will navigate the application process with confidence.

Follow the steps to successfully complete the form.

1. Click the ‘Get Form’ button to obtain the form and open it in your preferred online editor.
2. Determine if you are submitting an initial or renewal application by checking the appropriate box at the top of the form.
3. Fill in the home care license expiration date if applicable.
4. Provide your 'Doing Business As' (DBA) name and home care license number, if applicable, along with your physical address, including city, state, zip code, and county.
5. Enter your legal entity name as recorded with the Minnesota Office of the Secretary of State, including federal and state tax ID numbers.
6. Designate an authorized agent to receive notices. Enter their name, title, telephone, and email address.
7. If applicable, provide contact information for an individual who can answer questions about the application. Check the box if this person is the same as the authorized agent.
8. Select all basic support services that you will provide from the list provided.
9. Be aware of compliance requirements with Minnesota Statutes for home and community-based services.
10. Enter the required fee based on whether you are an initial or renewal applicant, ensuring to distinguish revenues derived from services under this designation.
11. Attach any required documentation for initial applicants, including an organization chart and program policies.
12. Review all information for accuracy, sign, and date the application.
13. Once completed, save your changes, and download or print the form for submission.

Complete your application online today to ensure timely processing!