Get Variance Request Form Mn Dhs

Navigating the Variance Request Form Mn Dhs can seem challenging, but this guide aims to offer clear, step-by-step instructions for users. By understanding each component of the form, you can successfully submit your request with confidence.

Follow the steps to fill out the Variance Request Form Mn Dhs online

1. Click ‘Get Form’ button to obtain the Variance Request Form and open it in your preferred editor.
2. Begin by completing the Agency/County Name and Licensor fields at the top of the form.
3. Fill in the Provider Name, Address, City, and Zip code, ensuring all details are accurate.
4. Select the Type of Care from the provided options: Child Foster Care, Family Child Care, or Adult Foster Care.
5. Complete the License # section by providing the appropriate license number.
6. Indicate the type of variance requested by checking the relevant boxes for each category that applies.
7. Answer the question about crisis services being provided in this home by selecting 'YES' or 'NO'.
8. In questions 1-5, provide the required details regarding compliance, reasons for the variance, and alternative measures for health and safety.
9. If applicable, include the name or initials and date of birth of the individual for whom the variance is being requested.
10. Fill in the begin and end dates of the variance request.
11. Indicate if this is a NEW request by checking the appropriate box.
12. Provide the county recommendation by indicating yes or no.
13. Sign the form in the Signature and title of person making recommendation section, and include your phone number.
14. If requesting a dual license variance, have the second licensor sign and provide their phone number.
15. If you have additional information to assist in processing the request, attach that documentation.
16. Once everything is filled out, save your changes and proceed to download, print, or share the form as needed.

Start filling out your Variance Request Form Mn Dhs online today to ensure a smooth submission process!