Department aging form oda 2026

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ohio department of aging provider certification Preview on Page 1

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  1. Click ‘Get Form’ to open the department aging form oda in the editor.
  2. Begin by filling out the 'Identifying Information' section. Enter your legal name, doing business as (if applicable), and relevant identification numbers such as Social Security and Federal Tax ID.
  3. Complete the 'Business Address' and 'Mailing/Billing Address' fields accurately, ensuring no post office boxes are used.
  4. In the 'Key Personnel' section, provide details for key individuals including the C.E.O. and agency administrator. If required, be prepared to include social security numbers for eligibility verification.
  5. Proceed to answer questions regarding ownership structure and any changes in key personnel over the past year. Attach explanations if necessary.
  6. Finally, review the 'Assurances' section carefully, ensuring all commitments are understood before signing and dating the application.

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