TITLE 59: MENTAL HEALTH
CHAPTER I: DEPARTMENT OF HUMAN SERVICES
PART 115 STANDARDS AND LICENSURE REQUIREMENTS FOR COMMUNITY-INTEGRATED LIVING ARRANGEMENTS
SECTION 115.410 LICENSE APPLICATION
Section 115.410 License application
1) Agencies shall apply by completing application forms available from:
Accreditation, Licensure and Certification
Department of Human Services
303 East Monroe, 2nd Floor
Springfield IL 62762
2) The application shall require agencies to certify that individuals being served and programs and services provided in CILAs comply with Section 4 of the Community-Integrated Living Arrangements Licensure and Certification Act, Chapter 2 of the Code, the Confidentiality Act and this Part. The application shall request information including, but not limited to:
A) The agency, including the type of ownership, the names of all owners, partners and stockholders;
B) The individuals being served or to be served in the CILAs supervised by the agency including their disabilities and diagnosis, any special needs such as visual or hearing impairments or mobility issues, the kind of supervision received and whether individuals are in living arrangements owned or leased by the agency;
C) The living arrangements used as CILA sites including site addresses and telephone numbers;
D) A budget of the agency's estimated first year expenses and revenues;
E) Policies and procedures of the agency;
F) Organizational chart, staffing patterns and staff qualifications for the agency.
3) The authorized agency representative shall sign and date the application forms.
The Department shall charge a licensure fee up to $200 as provided by Section 4(d) of the Community-Integrated Living Arrangements Licensure and Certification Act.
On Department notification, each licensed agency shall submit a signed and dated renewal application at least 120 days prior to expiration of the license.
(Source: Amended at 27 Ill. Reg. 5376, effective March 17, 2003)