Renewal Application for License for HIV Supportive Living Facility 2026

1. Click ‘Get Form’ to open the Renewal Application for License for HIV Supportive Living Facility in our editor.
2. Begin by entering the Name of the Facility/Agency, Facility License Number, and Location details including Street, City, County, State, Zip, and Phone Number.
3. Indicate whether your facility has a secured unit by selecting 'Yes' or 'No', and provide the Number of Secured Beds if applicable.
4. Fill in the Administrator's name and Certification Number. If your mailing address differs from the facility location, provide that information as well.
5. Complete the Ownership of Building section by providing the owner's name and contact details.
6. In the Ownership of Business section, check the type of Legal Entity and indicate if it is For Profit or Non-profit. Provide details about individual owners or partners as required.
7. Answer questions regarding accreditation status and chain affiliation. If applicable, list parent company details.
8. Finally, verify your application by signing it and providing your title or position along with the date.

Start filling out your Renewal Application today using our platform for free!