Indiana state 2026

1. Click ‘Get Form’ to open the Indiana State Application for License to Operate a Home Health Agency in our editor.
2. Begin with SECTION I, where you will select the type of application. Choose between 'New Facility' or 'Change of Ownership' and provide the anticipated date if applicable.
3. In SECTION II, fill out your identifying information. Include the name of your agency, address, contact details, and office hours. Ensure that all fields are completed legibly.
4. Proceed to SECTION III for staffing details. Provide names and qualifications of key personnel such as the Administrator and Clinical Supervisor, along with required documentation like resumes and licenses.
5. Complete SECTION IV by listing ownership information. Include names and addresses of individuals with significant ownership interests.
6. Finally, review all sections for completeness before submitting your application along with the non-refundable fee of $250.

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