State form 53391 2025

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The document is an application form for obtaining a license to operate a Personal Services Agency in Indiana. It outlines the necessary steps, required information, and documentation needed for submission, including details about ownership, agency location, staffing, and compliance with state regulations. A non-refundable fee of $250 is required, and the application must be completed fully to avoid rejection. Additionally, it specifies policies and procedures that must be submitted alongside the application.

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How many kids can you babysit without a license in Indiana?

Practitioners must hold a CSR in order to prescribe, administer, store, dispense or otherwise handle controlled substances in the State of Indiana. One CSR is sufficient for a practitioner to prescribe controlled substances throughout Indiana.

What is a personal service agency in Indiana?

The Indiana Department of Health licenses agencies that provide (1) attendant care services; (2) homemaker services that assist with or perform household tasks, including housekeeping, shopping, laundry, meal planning and preparation, and cleaning; and (3) companion services that provide fellowship, care, and

What is an Indiana CSR license?

Effective July 1, 2023, private employment agencies will no longer need to register or renew their license with DOR, while temporary healthcare service agencies will be required to apply for a license with the Indiana Department of Health.

How to get a personal services agency license in Indiana?

Prior to operating a Personal Services Agency in Indiana, a license must be obtained from the Indiana Department of Health (IDOH) To obtain a license, the applicant must submit to IDOH a completed application on the designated form, supporting documentation and $250.00 licensure fee, and must be able to show compliance