Section 435.515 - Provisional certificate: Submission and contents of applicationA completed application for a provisional certificate must be submitted to the Division, on a form furnished by the Division, and must include, without limitation:
1. For a provider of supported living arrangement services who is a natural person: (a) Proof that the applicant is 18 years of age or older;(b) Three or more letters of professional reference;(c) Proof that the applicant has successfully completed a classroom course in cardiopulmonary resuscitation according to the guidelines of the American Red Cross or American Heart Association;(d) Proof that the applicant is currently certified in standard first aid through:(1) A course from the American Red Cross;(2) A course from the American Heart Association; or(3) An equivalent course in standard first aid, if the applicant submits proof that such course meets or exceeds the requirements of the American Red Cross or American Heart Association;(e) Written verification, on a form prescribed by the Division, stating that the fingerprints of the applicant were taken and directly forwarded electronically or by another means to the Central Repository for Nevada Records of Criminal History and that the applicant has given written permission to the law enforcement agency or other authorized entity taking the fingerprints to submit the fingerprints to the Central Repository for submission to the Federal Bureau of Investigation for a report on the applicant's background and to such other law enforcement agencies as the Division deems necessary;(f) Proof that the applicant has sufficient working capital to ensure that the applicant would be financially capable of providing supported living arrangement services for a period of at least 3 months without compensation;(g) Proof that the applicant satisfies the same or similar criteria of a qualified intellectual disability professional set forth in 42 C.F.R. § 483.430 or has obtained a waiver of the criteria from the applicable regional center;(h) If applicable, a copy of the applicant's state business license and a copy of the current business license issued for the applicant's business by the county, city or town in which the applicant's business is located or written verification that the applicant is exempt from any requirement to obtain a business license;(i) Proof of industrial insurance in compliance with chapters 616A to 616D, inclusive, of NRS or an affidavit stating that the applicant has elected not to be included within the terms, conditions and provisions of chapters 616A to 616D, inclusive, of NRS pursuant to NRS 616B.659; and(j) Any other information required by the Division.2. For a provider of supported living arrangement services that is an organization consisting of a partnership, firm, corporation, association, state or local government or agency thereof: (a) If applicable, a copy of the state business license of the organization and a copy of the current business license issued for the organization's business by the county, city or town in which the organization is located or written verification that the organization is exempt from any requirement to obtain a business license;(b) The federal tax identification number of the organization;(c) A copy of the bylaws, articles of incorporation, articles of association, articles of organization, partnership agreement, constitution and any other substantially equivalent documents of the organization, and any amendments thereto;(d) A list of the members of the governing body of the organization which includes the terms of office of those members; (e) If the applicant is an association or a corporation:(1) The name, title and principal business address of each officer and member of its governing body; and(2) The signature of the chief executive officer or an authorized representative;(f) If the applicant is a corporation, the name and address of each person holding more than 10 percent of its stock;(g) Proof that at least one supervisor, administrator or manager of the provider satisfies the same or similar criteria of a qualified intellectual disability professional set forth in 42 C.F.R. § 483.430 or has obtained a waiver of the criteria from the applicable regional center;(h) For each officer or other person who oversees the provision of supported living arrangement services: (1) Three or more letters of professional reference; and(2) Written verification, on a form prescribed by the Division, stating that the fingerprints of the officer or other person were taken and directly forwarded electronically or by another means to the Central Repository for Nevada Records of Criminal History and that the officer or other person has given written permission to the law enforcement agency or other authorized entity taking the fingerprints to submit the fingerprints to the Central Repository for submission to the Federal Bureau of Investigation for a report on the background of the officer or other person and to such other law enforcement agencies as the Division deems necessary;(i) Proof that the applicant has sufficient working capital to ensure that the provider is financially capable of providing supported living arrangement services for a period of at least 3 months without compensation;(j) Copies of any policies and procedures of the organization relating to the provision of supported living arrangement services;(k) Proof that the applicant has an office independent of the location where supported living arrangement services are provided;(l) Proof of industrial insurance in compliance with chapters 616A to 616D, inclusive, of NRS; and(m) Such other information as may be required by the Division.Nev. Admin. Code § 435.515
[Men. Hygiene & Men. Retardation Div., Residences § 4 subsecs. 1 & 2, eff. 2-5-82]-(NAC A by Div. of Men. Health & Dev. Services by R071-06, 11-13-2006); A by R144-16AP, eff. 5/16/2018