Pennsylvania dp form 2026

1. Click ‘Get Form’ to open the Pennsylvania DP form in the editor.
2. Begin by entering your provider information, including the legal entity name, street address, city/state/zip, and phone number. Ensure all details are accurate for effective communication.
3. Fill in the site location code and licensed capacity. This information is crucial for tracking residential habilitation services.
4. Indicate the date of vacancy and select the reason from the provided options such as death or moving out of Pennsylvania. This helps in understanding the context of the vacancy.
5. If applicable, attach a movement plan detailing any internal moves planned. Include names, reasons for moves, affected locations, and projected dates.
6. Complete the individual’s information section by providing their name, MCI number, county of registration, and waiver status.
7. Finally, ensure that all fields are filled out correctly before submitting your form to the appropriate regional Waiver Capacity Manager within three business days.

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