Application for Skilled Nursing Facilities

Fees

Credit card payment must be remitted at time of submission.

License Fee Schedule

License Fee	$ 10.00/per bed

Application Signature

There will be 2 required signatures on the Application. The administrator of the facility shall not sign the Application unless he/she is also a board member. The Application must be signed by official(s) of the entity responsible for the operation of the facility. (If sole proprietorship, the owner shall sign the Application; if a corporation, two of its officers shall sign; if a state, county, or municipal unit, the Application is to be signed by the head of the department having jurisdiction over the facility.)

Floor Plan

Please have a floor plan ready to be uploaded into the Application as this is required.

Application Approval Process

Once you have submitted the application, it will be sent for approval. Once the application has been reviewed and approved, the contact for the facility will receive an email letting them know it has been approved. The facility may then go to the website and print a license.