FCH Renewal application 2007 - ncdhhs-2025

1. Click ‘Get Form’ to open the FCH Renewal application in the editor.
2. Begin with Part A, where you will enter your facility's name and address. Ensure that the name matches exactly as it appears on your current license.
3. In Part B, provide details about the certified administrator(s) if applicable. Include their certificate number and contact information.
4. Complete the legal identity section by verifying or correcting the preprinted information for the licensee. Mark through any incorrect details in red and write in the correct information.
5. For ownership disclosure in Part C, list all individuals or entities holding a 5% or more interest in your facility. Attach additional pages if necessary.
6. Fill out census data in Part D accurately, ensuring totals match where required. This includes resident counts and financial information.
7. Finally, review all sections for completeness before submitting your application along with the annual fee to avoid delays.

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