Get Change Of Ownership Application For License To Operate A Home

Filling out the Change of Ownership Application for License to Operate a Home Health Agency is an essential step for ensuring compliance with state regulations. This guide provides clear, step-by-step instructions to assist you in navigating the online form effectively.

Follow the steps to successfully complete your application.

1. Use the ‘Get Form’ button to access the Change of Ownership Application for License to Operate a Home Health Agency and open it in your browser.
2. Identify the section for the type of application. Check the appropriate box for Change of Ownership to indicate the nature of your application.
3. Fill in the identifying information. Ensure you accurately provide the doing business name, and make sure it is registered with the Indiana Secretary of State. Include a generic email address and a reliable mailing address for communications.
4. In the staffing section, provide qualifications for each designated position. Ensure that candidates meet state and federal guidelines, particularly for supervisory and management roles.
5. Complete the ownership and controlling interest section by selecting the type of entity under which your agency is registered. Ensure that this corresponds accurately with documents provided from the Secretary of State.
6. Review your application thoroughly to ensure all required supporting documents are included. This includes the purchase agreement, letters of intent, and criminal history checks as outlined in the requirements.
7. After confirming completion, save your changes. You may then download or print the application, ensuring you retain a copy for your records.
8. Submit the completed application along with the required non-refundable application fee of $250.00 to the Indiana State Department of Health at the specified address.

Begin the process of your application online today and ensure your Home Health Agency is properly licensed.