New Hampshire Code of Administrative Rules
He - Department of Health and Human Services
Subtitle He-M - Former Division of Mental Health and Developmental Services
Chapter He-M 1000 - HOUSING
Part He-M 1001 - CERTIFICATION STANDARDS FOR COMMUNITY RESIDENCES
Section He-M 1001.20 - Required Forms

Universal Citation: NH Admin Rules He-M 1001.20

Current through Register No. 40, October 3, 2024

(a) Applicants or community residences applying for an initial or renewal certification shall complete and submit the form entitled "Request for Certification of Community Residence and/or Individual Day Provider" (1/1/09 edition) .

(b) Applicants applying for emergency certification shall:

(1) Complete and submit the form entitled "Emergency Certification for Community Residences- 3 or Fewer Beds" (7/1/02 edition); and

(2) Include a signature from the provider agency representative and the executive director of the responsible area agency that verifies that the appropriate staff determined that the home meets the requirements of He-M 503, He-M 522, He-M 1001, He-M 1201, and He-M 507, as applicable.

(c) Forms completed in accordance with (a) or (b) above shall be submitted to:

Department of Health and Human Services

Office of Operations Support

Health Facilities Administration

129 Pleasant Street

Concord NH 03301

(d) Applicants or community residences applying for a waiver shall:

(1) Complete and submit the form entitled "NH bureau of Developmental Services Waiver Request" (September 2007 edition); and

(2) Include a signature from the individual(s) or legal guardian(s) indicating agreement with the request and the area agency's executive director or designee recommending approval of the waiver.

#9776-B, eff 10-1-10

The amended version of this section by New Hampshire Register Volume 39, Number 37, eff.8/20/2019 is not yet available.

The amended version of this section by New Hampshire Register Number 45, eff. 10/21/2023 is not yet available.

Disclaimer: These regulations may not be the most recent version. New Hampshire may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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