Application and Fees
(1)Application for a Certificate of Registration shall be submitted by the operator in writing on a form provided by the Division. The application shall include but not be limited to:
(a)A description of the property or place in or upon which the applicant proposes to maintain or conduct a room and board facility;
(b)The maximum number of residents who can reside at the facility;
(c)The names of all residents residing at the facility at the time of application;
(d)The number of floors to be occupied;
(e)The number of beds on each floor;
(f)The name, address, telephone number, birth date, and Social Security number of the applicant;
(g)The names, addresses, telephone numbers, birth dates, and Social Security numbers of any partner, corporate officer or other persons having a financial interest in the property;
(h)The name, address, telephone number, birth date, and Social Security number of the resident manager, if applicable;
(i)A description of services which will be offered to residents;
(j)A copy of the residency agreement; and
(k)Signed and dated forms, SDS 303, for release of criminal records for the applicant and the resident manager, if applicable;
(l)A signed and dated statement from the operator stating that the operator and the facility are in compliance with all the requirements of these rules.
(2)The registration fee shall be $20 per year, per facility, and shall accompany the application.
(3)The application shall not be considered complete until all the required information and the application fee are received by the Division.
Rule 411-068-0010 — Application and Fees,