Get Or Loi-1

Filling out the OR LOI-1 form is an essential step for entities looking to implement new health services or facilities. This guide will provide you with comprehensive, step-by-step instructions to help you accurately complete the form online.

Follow the steps to accurately complete the OR LOI-1 form.

1. Click the ‘Get Form’ button to obtain the form and access it in your preferred online editor. This allows you to enter your information directly into the document.
2. Fill in the date at the top of the form. This ensures that your submission is timely and can be processed efficiently.
3. Provide the name of the entity that will carry out the proposed project. Follow this by entering its address, including city, state, and zip code, as well as a phone number and the name of a contact person.
4. If a different individual is filling out the form on behalf of the entity, include their name, address, city, state, zip code, and phone number.
5. Write a general project description to outline the purpose and scope of the proposed project clearly.
6. Estimate the capital expenditures for the project, excluding any interest. If financing is involved, specify the term in years, interest rate, and total interest expenses.
7. Complete section 5 only if proposing new hospital services. Indicate projected operating costs for the first fiscal year along with supporting budgetary information and attach a budget forecast for the first three years of operation.
8. For long-term care facility projects, indicate if you propose a new facility or service and provide the necessary details regarding bed capacities and facility changes.
9. Use the section to identify the approximate location of the new facility or service under consideration.
10. Answer any additional questions regarding the project's relationship with existing health services or facilities, ensuring clarity about the scope and impact.
11. Indicate anticipated timelines for application submission and project implementation, concluding with the necessary signatures, dates, and position of the signatory.
12. Once all fields are completed, save your changes and choose to download, print, or share the form as needed.

Complete your documents online effortlessly by following these steps.