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Hs 633 application for certificate

HS 633 2025

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4.2 out of 5

28 votes

The document is an application form for a Certificate of Compliance for a facility or agency in Pennsylvania. It outlines the purpose of the application, which can be for a new facility or renewal of an existing certificate. The form requires detailed information about the agency/facility, legal entity, responsible person, type of service provided, and ownership structure. Additionally, it includes questions regarding prior license status and criminal history of the legal entity or operator. Attachments such as the Certificate of Occupancy and Articles of Incorporation are required for initial applications. A declaration section emphasizes compliance with relevant laws and regulations.

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Click ‘Get Form’ to open HS 633 in the editor.
Begin by filling out the 'Identification' section. Enter the name and address of your agency/facility, along with the legal entity's details including email and phone number.
In the 'County and Municipality' field, specify where your facility is located. This helps in identifying local regulations.
Provide information about the responsible person managing daily operations, including their name and title.
Indicate the type of agency/facility service you provide. Choose from options like Mental Health Facilities or Human Service Programs for accurate classification.
If applicable, fill in the requested/licensed capacity for Personal Care Homes or Assisted Living Residences.
Complete the section regarding ownership type and attach any required documents such as Certificates of Occupancy or Articles of Incorporation.
Finally, review your entries for accuracy, sign the declaration, and submit your application through our platform.

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Versions	Form popularity	Fillable & printable
2016	4.2 Satisfied (28 Votes)
2009	4 Satisfied (37 Votes)

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

How do I become an assisted living administrator in Pennsylvania?

ing to 55 PA Code Chapter 2800, prior to employment as an Assisted Living Administrator, you must take this 15-hour training program in addition to the 100-hour Personal Care Home Administrator training and exam.

How many children can I watch without a license in PA?

Child care and early learning providers operating a program for four or more unrelated children must be certified by the Pennsylvania Department of Human Services.

Who regulates group homes in Pennsylvania?

The Bureau of Certification Services is responsible for the regulation of all child care centers, group day care homes and family day care homes in Pennsylvania. The Certification Bureau receives inquiries regarding a variety of topics, including: The requirements and process for opening a child care facility.

Who licenses assisted living facilities in PA?

Assisted living residences (ALRs) are licensed by the Department of Aging, Office of Long Term Living, Division of Licensing, and personal care homes are licensed by the Department of Public Welfare, Adult Residential Licensing.

What certifications are needed to open a group home in PA?

A group child care home must have a certificate of compliance (license) from DHS in order to legally operate. Family Child Care Home: A child care facility located in a home in which four, five, or six children who are not related to the caregiver receive child care.