Get Conversion Program

Filling out the Conversion Program form online can be a straightforward process with the right guidance. This guide will provide you with clear instructions for each section of the form to ensure your submission is accurate and completed efficiently.

Follow the steps to successfully complete the Conversion Program form.

1. Click ‘Get Form’ button to obtain the Conversion Program form and access it in the editor.
2. Begin with section 1 and enter the voucher number. This number is essential for tracking your request.
3. In section 2, specify the LOCCS program area by entering 'ALCP' to indicate you are using the Assisted Living Conversion Program.
4. For section 3, indicate the period covered by this request in the format mm/yyyy. Include both the start and end dates.
5. In section 4, select either '1' for a partial disbursement or '2' for a final disbursement.
6. Fill in the voice response number in section 5, ensuring it follows the specified format of five digits, a hyphen, followed by five more digits.
7. Enter the grantee organization’s name in section 6 as it appears in official documents.
8. In section 7, provide the payee organization's name.
9. In section 8, include the grant or project number associated with your application.
10. In sections 6a and 7a, enter the Tax Identification Number (TIN) for the grantee and payee organizations, respectively.
11. Proceed to section 9 where you will list the line item numbers, types of funds requested, and their respective amounts in dollars and cents.
12. Calculate the total amount requested in section 10 and enter it in the designated field.
13. In section 11, provide the name and phone number of the person who completed the form, including the area code.
14. Complete section 12 by entering the name and title of the authorized signatory, ensuring clarity.
15. Sign the form in section 13 and date the request in section 14 using the mm/dd/yyyy format.
16. Once all fields are accurately filled, save your changes. You can then download, print, or share the form as needed.

Complete your documents online now for an efficient submission process.