Get Mn Doh Hcalp-f0070 2020-2025

Filling out the MN DOH HCALP-F0070 form is an essential step for licensed home care providers seeking an integrated license for home and community-based services. This guide provides a user-friendly walkthrough to ensure accurate completion of the form.

Follow the steps to successfully complete the form online.

1. Click the ‘Get Form’ button to obtain the form and open it in your preferred online editor.
2. Select whether you are submitting a renewal or initial application by checking the appropriate box.
3. Provide your applicant information, including the 'Doing Business As' name, physical address, county, telephone, and fax number. Ensure that all data is accurate and complete.
4. Enter your legal entity name, along with your Federal and State Tax ID numbers.
5. Designate one agent authorized to receive notices and orders. Include their title, telephone, and email address.
6. Provide the name and contact information for an individual to reach out to if there are questions regarding the application. Check the box if this is the same as the designated agent.
7. Select all basic support services you will provide by checking the applicable boxes as outlined under section 245D.03.
8. Understand and ensure compliance with the licensing requirements for home care providers as summarized in the form.
9. Determine the applicable fee based on your type of application (initial or renewal) and the revenue derived from services under the designation. Prepare the payment for submission.
10. For initial applicants, attach the required documentation as specified in the form, including the organization chart and program policies.
11. Have the authorized agent sign and date the application.
12. Once completed, save your changes and download or print the form for submission. Make sure to mail it to the Minnesota Department of Health as indicated in the submission requirements.

Complete your application online today to ensure proper licensure and compliance.