State of wisconsin chapter 500332m wis stats page 1of 4 2013 form-2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out the 'General Information' section. Enter the facility name, contact details, and address accurately to ensure proper identification.
3. In the 'Designated Mail Recipient' section, provide the contact information for the individual who will receive correspondence from DHS/DQA.
4. Complete the 'Facility Information' section by indicating whether this is a conversion from another type of facility and providing details about your RCAC structure.
5. Fill out the 'Applicant Information' section, selecting your entity type and providing ownership details as required.
6. In the 'Applicant Ownership' section, list all individuals or entities with ownership interest in the facility, ensuring accuracy to avoid processing delays.
7. Finally, review all sections for completeness and accuracy before signing in the 'Attestation' area to confirm that all information is truthful.

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