Get Group Home Program Rate Application Sr 1 Form 2020-2026

Filling out the Group Home Program Rate Application Sr 1 Form is an essential step for organizations seeking to operate group home programs. This guide will provide you with a comprehensive, step-by-step approach to ensure you successfully complete the application online.

Follow the steps to fill out the application accurately.

1. Click ‘Get Form’ button to access the Group Home Program Rate Application Sr 1 Form and open it for editing.
2. Select the type of application you are submitting by checking one of the boxes. Options include ongoing, new provider, new program, program change, licensed capacity change, relocation, or reinstate. Make sure you only check one box.
3. Provide the year and proposed effective date for your application.
4. Enter the provider or licensee name as stated on the group home license.
5. Fill in the program name if applicable. If you do not have a specific program name, this field may be left blank.
6. Record the program number if available; otherwise, leave it blank for new applications.
7. Complete the mailing address fields, including number, street, city, state abbreviation, and zip code.
8. Input the names and contact information for the executive director, CCL approved administrator, and contact person for the application.
9. Indicate whether the agency is a non-profit organization and whether it operates any other businesses. Provide details if applicable.
10. List the total licensed capacity of the facilities used by the program and other operational details as required.
11. In the certification section, the executive director or authorized officer must read the certification statements, sign, and complete the required information, including title, county and state where signed, and the date.
12. Review the completed application for accuracy, then proceed to save, download, and print the form if needed, or share it with relevant parties.

Complete your Group Home Program Rate Application Sr 1 Form online to ensure timely processing!