Ariz. Admin. Code § R6-6-1507 - Application for an Hcbs Certificate Renewal

Current through Register Vol. 27, No. 52, December 24, 2021

A. The Division shall send a notice of renewal to the service provider 60 days prior to the expiration of the HCBS certificate.

B. Not more than 30 days and not less than 10 days prior to the expiration date of a current HCBS certificate, an applicant shall apply to the Division for renewal on a form provided and prescribed by the Division. The form shall contain the following information:

1. Name;

2. Home and business address;

3. Social security number or tax identification number;

4. AHCCCS registration number;

5. Phone number; and

6. Any services which the applicant wishes to:

a. Provide in addition to services currently on the HCBS certificate; or

b. Delete from services currently on the HCBS certificate.

C. The applicant shall include a copy of current licenses and training as required by this Article.

Notes

Ariz. Admin. Code § R6-6-1507

Adopted effective February 1, 1996; filed in the Office of the Secretary of State December 26, 1995 (Supp. 95-4).