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- Click ‘Get Form’ to open the hs 200 in the editor.
- Begin with Section A, APPLICATION INFORMATION. Select the type of application by checking one of the options: Initial, Change of Ownership, Management Company, or Other Change.
- For Change of Ownership applications, provide the effective date of ownership change in item 2. Enter the amount of fee enclosed in item 3.
- In item 4, check all applicable types of changes and specify the type of facility in item 5 by selecting from the provided options.
- Proceed to Section B for LICENSEE INFORMATION. Fill in your licensee name and federal employer’s tax ID number. Ensure that all contact details are accurate.
- Complete Section C with FACILITY, AGENCY OR CLINIC INFORMATION. Provide details about management agreements if applicable and ensure all required attachments are included.
- Finally, review all sections for accuracy before submitting your application through our platform.
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| Versions | Form popularity | Fillable & printable |
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| 2008 | 4.9 Satisfied (401 Votes) |
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