Current through September 16, 2024
A completed application for a provisional certificate must be
submitted to the Division, on a form furnished by the Division, and must
include, without limitation:
1. For a
provider of supported living arrangement services who is a natural person:
(a) Proof that the applicant is 18 years of
age or older;
(b) Three or more
letters of professional reference;
(c) Proof that the applicant has successfully
completed a classroom course in cardiopulmonary resuscitation according to the
guidelines of the American Red Cross or American Heart Association;
(d) Proof that the applicant is currently
certified in standard first aid through:
(1) A
course from the American Red Cross;
(2) A course from the American Heart
Association; or
(3) An equivalent
course in standard first aid, if the applicant submits proof that such course
meets or exceeds the requirements of the American Red Cross or American Heart
Association;
(e) A set of
fingerprints submitted to the applicable regional center for submission to the
Central Repository for Nevada Records of Criminal History and written
permission for the regional center to submit the fingerprints to the Central
Repository for submission to the Federal Bureau of Investigation for a report
on the applicant's background and to such other law enforcement agencies as the
Division deems necessary;
(f) Proof
that the applicant has sufficient working capital to ensure that the applicant
would be financially capable of providing supported living arrangement services
for a period of at least 3 months without compensation;
(g) Proof that the applicant satisfies the
same or similar criteria of a qualified intellectual disability professional
set forth in 42 C.F.R.
§
483.430 or has obtained a waiver of
the criteria from the applicable regional center;
(h) If applicable, a copy of the applicant's
state business license and a copy of the current business license issued for
the applicant's business by the county, city or town in which the applicant's
business is located or written verification that the applicant is exempt from
any requirement to obtain a business license;
(i) Proof of industrial insurance in
compliance with chapters 616A to 616D, inclusive, of NRS or an affidavit
stating that the applicant has elected not to be included within the terms,
conditions and provisions of chapters 616A to 616D, inclusive, of NRS pursuant
to NRS
616B.659; and
(j) Any other information required by the
Division.
2. For a
provider of supported living arrangement services that is an organization
consisting of a partnership, firm, corporation, association, state or local
government or agency thereof:
(a) If
applicable, a copy of the state business license of the organization and a copy
of the current business license issued for the organization's business by the
county, city or town in which the organization is located or written
verification that the organization is exempt from any requirement to obtain a
business license;
(b) The federal
tax identification number of the organization;
(c) A copy of the bylaws, articles of
incorporation, articles of association, articles of organization, partnership
agreement, constitution and any other substantially equivalent documents of the
organization, and any amendments thereto;
(d) A list of the members of the governing
body of the organization which includes the terms of office of those
members;
(e) If the applicant is an
association or a corporation:
(1) The name,
title and principal business address of each officer and member of its
governing body; and
(2) The
signature of the chief executive officer or an authorized
representative;
(f) If
the applicant is a corporation, the name and address of each person holding
more than 10 percent of its stock;
(g) Proof that at least one supervisor,
administrator or manager of the provider satisfies the same or similar criteria
of a qualified intellectual disability professional set forth in
42 C.F.R. §
483.430;
(h) Verification that the applicant has
established an account with the Central Repository for Nevada Records of
Criminal History pursuant to
NRS
179A.325;
(i) For each officer or other person who
oversees the provision of supported living arrangement services:
(1) Three or more letters of professional
reference; and
(2) Verification
that:
(I) The fingerprints of the officer or
other person were taken and directly forwarded electronically or by another
means to the Central Repository; and
(II) The officer or other person has given
written permission to the entity taking the fingerprints to submit the
fingerprints to the Central Repository for submission to the Federal Bureau of
Investigation for a report on the background of the officer or other person and
to such other law enforcement agencies as the Division deems
necessary;
(j)
Proof that the applicant has sufficient working capital to ensure that the
provider is financially capable of providing supported living arrangement
services for a period of at least 3 months without compensation;
(k) Copies of any policies and procedures of
the organization relating to the provision of supported living arrangement
services;
(l) Proof that the
applicant has an office independent of the location where supported living
arrangement services are provided;
(m) Proof of industrial insurance in
compliance with chapters 616A to 616D, inclusive, of NRS; and
(n) Such other information as may be required
by the Division.
[Men. Hygiene
& Men. Retardation Div., Residences § 4 subsecs. 1 & 2, eff.
2-5-82]-(NAC A by Div. of Men. Health & Dev. Services by R071-06,
11-13-2006); A by
R144-16AP,
eff. 5/16/2018; A by
R026-24A,
eff. 8/13/2024
NRS 435.333