Renewal of an Adult Family Foster Care License 660-05-20-20
(Revised
6/16/08 ML 3147)
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An application to renew an AFFC license is not complete until all required
information and verifications are submitted to the County Social Service
Agency, the Human Service Center and the Division. This includes:
Must
be present in file from initial license:
- SFN 1013,
“Application to Provide Adult Family Foster Care”
- Floor plan indicating escape
routes
- Examples of service logs
to account for service time and tasks performed
- Examples of daily menu
plans
- Three reference letters
- SFN 823,
"Family Evacuation Disaster Plan"
Required
for license renewal:
- A completed SFN 1031, “Relicensing Study – Adult Family Foster
Care”
- Evidence that all caregivers
have requested renewal of qualified service provider status and completed:
- SFN 980,
“Individual Request to be a Qualified Service Provider/AFFC Provider”
- SFN 750,
“Documentation of Competency,” or applicable license, certification, or
accreditation
- If a background check was
not completed previously or a break in licensure has occurred, or if the
provider has not been continuously licensed since August 1, 1999, evidence
that all AFFC applicants and individuals age 18 or over living in the
AFFC home have completed:
- SFN 467, “Personal Authorization
for Criminal Record Inquiry”
- SFN 466, “Background Check
Address Disclosure”
- Two fingerprinting cards,
if required
- A new SFN
800, “Fire Safety Self Declaration,” form
- Documentation of applicant’s
current completion of the Department of Human Services approved Fire Prevention
and Safety Course
- Current proof of both home
and auto insurance
- A copy of the provider’s
preadmission information and house rules reviewed by the AFFC provider
(Section 05-30-45)
- A report of a professional
inspection of all heating units, to include furnace, water heater, and
alternate heating devices, is required upon license renewal. (Section
05-30-30 (2))
- If applicable, proof of
up to date pet vaccinations
- Additional information
and verifications as requested by the Human Service Center and/or Division
(Section 05-20-15-05)
