(Revised 1/1/08 ML 3118)
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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
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)
