Adult Foster Home (AFHDD) License Application Development Disabilities Program Section 1 Instructions New Applicants: Complete the License Application and other required licensing materials; attach.
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How to use or fill out the OR SDS 0654 online
Filling out the OR SDS 0654 form is an important step in the application process for Adult Foster Home licensing. This guide will walk you through the process of completing the form online, ensuring that you provide all necessary information accurately and efficiently.
Follow the steps to complete the OR SDS 0654 form online.
- Click the ‘Get Form’ button to access the form and initiate the filling process.
- Begin with Section 1, where you'll select the application type by checking all that apply: New, Renewal, Change of address, or Classification types. Make sure to include the required $20.00 non-refundable fee per bed.
- In Section 2, provide all requested AFH-DD home information including your name, phone number, site address, and type of dwelling. Be sure to indicate whether you own or rent the property, and include landlord information if applicable.
- List all occupants who live in the home, including individuals receiving care, and provide their Social Security numbers and dates of birth. If needed, attach an additional sheet.
- Answer questions about household pets, smoking policies, and living arrangements. Make sure to provide details on the second means of egress and any physical features of the home.
- Move to Section 3 to detail your provider information. List your education, employment history relevant to caregiving, and personal and professional emergency contacts.
- In this section, specify whether you have ever been licensed by another agency and list any other homes operated by you or associated individuals.
- Complete the business information section if applicable, including your business name, tax ID number, and legal status.
- In Section 4, list all caregivers, including their social security numbers and positions held. Confirm that you have obtained the necessary approvals and certifications.
- Finally, ensure you declare the information's accuracy and sign the application. Review all sections for completeness before submitting.
- Once completed, save your changes, download a copy for your records, print the form, or share it with the relevant authorities as required.
Start filling out your OR SDS 0654 form online today to ensure your application is processed efficiently.
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