AGING AND DISABILITY SERVICES ADMINISTRATION
2005 AFH "Dear Provider" Letters
July 20, 2005
ADSA: AFH #2005-010
COMPLETION & PROCESSING OF Background Authorization Forms
SUBMITTING CHANGE REQUESTS IN WRITING
Dear Adult Family Home Provider:
The intent of this letter is to clarify how Background Authorization forms are to be filled out and how processed results are returned to the facility. It is also to inform providers that there is a written requirement to change the facility fax number or mailing address for processed background results to be returned to the facility.
- In Box #1 of the Background Authorization form, the exact facility name as listed shown on the your Adult Family Home license application form must be listed. The facility name must be the same as and the registered trade name on your master business license . If the names are not the same, you must register the current facility name as a trade name. must be listed. The site address must also be listed.
- Background Authorization forms that are mailed to the Background Check Central Unit (BCCU) for processing will only be mailed back to the mailing address as listed in the Department’s Adult Family Home Tracking System.
- Background Authorization forms faxed to the BCCU for processing will only be faxed back to the fax number listed in the Department’s tracking system. If the facility has no fax number listed in the Department’s tracking system, the processed forms will be mailed back to the mailing address as listed in the Department’s tracking system.
- Effective immediately, to change a facility name, fax number or mailing address the facility must provide the AFH Licensor with a written request. The request must contain the new information to be entered into the Department’s AFH Tracking System.
If you are unsure of the facility name as listed in the Department’s tracking system, please contact your AFH Licensor. If you have further questions, please contact the Business Analysis and Applications Unit at (360) 725-2420, Extension 1.
Sincerely,
Joyce Pashley Stockwell, Director
Residential Care Services
