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Ds1852 2026
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- Click ‘Get Form’ to open the ds1852 in the editor.
- Begin by filling out the 'Request for Approval' section. Indicate whether you are seeking initial program plan approval, conversion from a CCF level facility, change of ownership, or new facility status.
- In the 'License Category' section, select the appropriate program plan type: ICF/DD-H, ICF/DD-N, or ICF/DD for annual approval.
- Enter your facility name and contact details including telephone, fax, and email. Ensure that you provide your Medi-Cal Provider ID if assigned.
- Complete the 'Facility Address' and 'Licensee/Corporation' sections with accurate information about your organization.
- Fill in the proposed/actual capacity and age range of residents. Specify ambulatory status as needed.
- Finally, sign and date the application in the 'Administrator' section before submitting it to the Department of Developmental Services.
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See more ds1852 versions
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| Versions | Form popularity | Fillable & printable |
|---|---|---|
| 2015 | 4.8 Satisfied (121 Votes) |
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