(application fee $700) Relocation (application fee $2750) • Current AFH address: • Current AFH license number: Section 2. Information about Proposed Adult Family Home 1. NAME OF PROPOSED ADULT FAMILY HOME 2. STREET ADDRESS CITY STATE 3. MAILING ADDRESS (IF DIFFERENT FROM ABOVE) ZIP CODE CITY 4. FACILITY TELEPHONE NUMBER 5. CONFIDENTIAL FAX NUMBER 6. CELL PHONE NUMBER 7. EMAIL ADDRESS REQUIRED COUNTY STATE ZIP CODE Section 3. Landlord Information (Property Owner(s)) Does the .
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How to fill out the WA DSHS 10-410 online
The WA DSHS 10-410 form, also known as the adult family home license application, is essential for individuals or entities seeking to operate an adult family home in Washington State. This guide provides step-by-step instructions to help you efficiently complete the application online.
Follow the steps to fill out the WA DSHS 10-410 online.
- Press the ‘Get Form’ button to access the WA DSHS 10-410 form and open it in your preferred editor.
- In Section 1, specify the type of application you are submitting by selecting either 'Initial,' 'Change of Ownership,' or 'Relocation.' Ensure you include the required application fee and your current adult family home (AFH) address and license number.
- Complete Section 2 by providing the name, street address, and contact details of the proposed adult family home. If your mailing address differs from the street address, include it here.
- Enter landlord information in Section 3. If the landlord is not the sole proprietor, indicate whether they will take an active interest in the operation of the adult family home.
- In Section 4, provide your Unified Business Identifier (UBI) number and Federal Employer Identification Number (EIN) if applicable.
- If your business structure is a corporation, partnership, or LLC, complete Section 5 with the legal name of your entity, contact numbers, and mailing address.
- Section 6 requires listing all individuals affiliated with the entity, including their titles, social security numbers, dates of birth, and percentage of ownership.
- In Section 7, fill in the name of the sole proprietor or entity representative and their name as it appears on their birth certificate.
- Provide information regarding your spouse or state registered domestic partner in Section 8, if applicable, including their name as it appears on the birth certificate.
- Section 9 requires the name of the resident manager, including their name as it appears on their birth certificate.
- In Section 10, indicate your intent regarding the admission and care of residents with specific needs, checking the applicable box.
- Fill out Section 11 regarding any past licensing, contracting, or certification history, making sure to provide details if you answer 'Yes' to any questions.
- Complete Section 12 by obtaining and submitting an online background authorization form for relevant individuals involved with the adult family home.
- Answer questions regarding current employment with state agencies in Section 13 and list any individuals employed in Section 14.
- In Section 15, certify the accuracy of your application and provide signatures where required, ensuring that you meet all the certification statements.
- Finally, review all sections for completeness and accuracy. Save your changes, then download, print, or share the completed WA DSHS 10-410 form as needed.
Complete your WA DSHS 10-410 application online today to ensure your adult family home meets all necessary licensing requirements.
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Get answers to your most pressing questions about US Legal Forms API.
What is the phone number for the EBT interview in Washington state?
If you are looking to schedule or ask questions about your EBT interview in Washington State, you can call 1-800-322-4386. This number connects you with staff familiar with the WA DSHS 10-410 process, making it easier to resolve any inquiries related to your benefits.
Who licenses adult family homes in Washington State?
In Washington State, the Department of Social and Health Services (DSHS) licenses adult family homes. They ensure these homes meet safety and quality standards for residents. For more details, you can refer to WA DSHS 10-410 guidelines to see the licensing process and standards in place.
How to apply for DSHS benefits in Washington?
To apply for DSHS benefits in Washington, visit the DSHS website and complete the online application. You can also apply in person at your local DSHS office or by calling the DSHS Customer Service Center. Following the WA DSHS 10-410 guidelines will ensure your application process is smooth and efficient.
How can I check the status of my food stamp case in Washington state?
You can check the status of your food stamp case in Washington state by visiting the Washington DSHS website or calling your local DSHS office. Additionally, accessing the online benefits portal can give you real-time updates related to WA DSHS 10-410. Ensuring you stay informed allows you to manage your benefits effectively.
How do I speak to someone at EBT Washington State?
To speak with someone regarding EBT services in Washington State, dial 1-877-328-9677. This helpline provides valuable information about your EBT card, including balance inquiries and transaction history related to WA DSHS 10-410. A representative will assist you promptly to address your needs.
What is the phone number for Washington DSHS food stamps?
To reach the Washington DSHS food stamps department, you can call 1-877-501-2233. This number connects you directly to resources for assistance with WA DSHS 10-410. Whether you have questions about your application or need further guidance, they are ready to help.
What is the monthly income limit for food stamps in Washington?
The monthly income limit for food stamps in Washington varies according to household size. For a household of one, the limit is approximately $1,064, while a household of four can earn up to about $2,185. These limits help determine eligibility for programs associated with WA DSHS 10-410, ensuring that assistance reaches those who need it most.
How do I renew my SNAP benefits in Washington State?
Renewing your SNAP benefits in Washington State involves completing and submitting a renewal application to DSHS. You can do this online through the DSHS website or by submitting a paper application. To ensure a smooth process, familiarize yourself with the WA DSHS 10-410 guidelines and consider using US Legal Forms for assistance with your renewal.
How do I submit documents to DSHS Washington State?
For submitting documents to DSHS Washington State, choose the method that best suits your situation: online, by mail, or in-person at a local office. Make sure to include all required information and verify that your documents are complete. If you need assistance, consider using US Legal Forms for help with the WA DSHS 10-410 document process.
How to submit documents to DSHS Washington State?
To submit documents to DSHS in Washington State, you can securely send them through their online portal, by mail, or in person at your local DSHS office. Each method has specific instructions available on the DSHS website. Using US Legal Forms can also provide templates and tips for effectively managing your WA DSHS 10-410 submissions.
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