Group home program rate application sr 1 form 2026

1. Click ‘Get Form’ to open the group home program rate application SR 1 in the editor.
2. Begin by selecting the type of application you are submitting: Ongoing, New Provider, New Program, Program Change, License Capacity Change, Relocation, or Reinstate.
3. Fill in the provider/licensee name and program name if applicable. Enter the program number if you have one; otherwise, leave it blank for new providers.
4. Complete your mailing address including number, street, city, state abbreviation, and zip code.
5. Provide contact details for the executive director including their name, phone number, fax number, and email address.
6. Continue filling out information for the CCL approved administrator and any additional contact persons as required.
7. Indicate whether your agency is a non-profit organization and if it operates any other businesses. Specify types of businesses if applicable.
8. In the certification section, ensure that all information is accurate before signing. The executive director or authorized officer must sign and date the application.

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