Licensing Standards for Home and Community Support Services Agencies Handbook

Forms Table of Contents

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2020Notification of Readiness for Initial Survey
2021License Application
2022Criminal History Check
2023Home and Community Support Services Agency Application for Medicare Certified Branch
2024Home and Community Support Services Agency Request for Alternate Delivery Site License
2025Home and Community Support Services Agency Request for Branch License
2026Request for Review and Approval of Administrator Training for Home and Community Support Services Agencies
3613Provider Investigation Report with Fax Cover Sheet (For HCSSA (or Home Health and Hospice) Provider Only)