Application for Integrated License: Home and Community-Based ... 2026

1. Click ‘Get Form’ to open the Application for Integrated License: Home and Community-Based Services in the editor.
2. Begin by selecting whether you are submitting a Renewal Application or an Initial Application. Fill in the home care license expiration date if applicable.
3. Complete the Applicant Information section, providing your 'Doing Business As' name, HFID number (if applicable), physical address, and contact details.
4. Designate an authorized agent who will receive all notices. Ensure to provide their contact information, including email.
5. In the Basic Support Services Offered section, check all services you will provide as outlined in section 245D.03.
6. Review the Fees section carefully. Calculate and enter your revenue from services under this designation if you are a renewal applicant.
7. Attach any required documentation for initial applicants, such as organization charts and program policies, before finalizing your application.

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