Instructions for Licensed Home Care Services Agency 2026

1. Click ‘Get Form’ to open the Instructions for Licensed Home Care Services Agency in the editor.
2. Begin by entering the identifying data, including the agency's name and address. Ensure that the operator's name is accurately filled out, and if it matches the agency, simply write 'same'.
3. In Section II, check the appropriate box that describes your application purpose (e.g., Initial Licensure) and provide a brief description.
4. For Section III, complete Table 1 by indicating all services provided, their delivery methods, and projected cases/visits. Attach any required documents as specified.
5. Ensure all attachments are numbered correctly in accordance with instructions throughout the form. This includes board resolutions and organizational structure descriptions.
6. Finally, review your entries for accuracy before submitting four copies of the application to the designated Bureau of Project Management.

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