Initial Application Forms

Most application forms are currently available on the DHS Forms website. Use the numbers provided below to find the forms:

• License Application, SDS 0654
  
• Application Instruction Sheet, SDS 0654i
• Foster Home Medicaid Provider Enrollment Agreement, SDS 0738
• Plan of Daily Operation, SDS 0656
• Consent for Release of Information, SDS 4533A
• AFH Financial Information, SDS 0448A
  

The following forms are also required, but they are not currently available on the DHS Forms website. You can download them here.

• Applicant List of References
  
• Floor Plan Guidelines
• AFH-DD Health History and Physician/Nurse Practitioner’s Statement