Get Application Fee (1) - Arizona Department Of Health Services

This guide provides clear instructions on how to complete the Application Fee (1) form for the Arizona Department of Health Services. By following these steps, you can ensure your form is filled out accurately and efficiently.

Follow the steps to complete your online application fee form.

1. Click 'Get Form' button to obtain the application fee form and open it in the editor.
2. Begin by filling out the name of your facility in the designated field. This ensures the application is associated with the correct entity.
3. Enter the CDC# (Child Development Center number) in the corresponding field for identification purposes.
4. In the next section, indicate your licensed capacity by checking the appropriate box: 5-10 licensed capacity, 11-59 licensed capacity, or 60+ licensed capacity. This determines the application fee amount.
5. Based on the checked box, note the corresponding fee amount: $1,000, $4,000, or $7,800.
6. If you wish to qualify for a fee reduction, check the box indicating your participation in the Empower Pack Program. This reduces the application fee by 50%.
7. Calculate the adjusted application fee based on your licensed capacity and the potential reduction from the Empower Pack Program. Enter these amounts in the indicated fields.
8. Enter any amounts you have already paid to the Department, if applicable. Make sure not to include any payments that were returned to you.
9. Calculate and enter the net amount due in the final section based on your entries.
10. Make your payment using a cashier's check, money order, or business check made payable to the Arizona Department of Health Services. Ensure to write your facility license number on the payment.
11. Mail the completed form along with payment to the appropriate office listed in the instructions, based on your facility's location. Keep a copy for your records.

Complete your application fee form online today for a smooth processing experience.