Application for Human Services Licensure

The Application for Certificate of Compliance (HS 633) is used to apply for a license to become a provider of human services programs.

Who Needs a Human Services License?

  • Adoption Services
  • County Children and Youth Agency
  • Day Treatment Program
  • Foster Family Care Agency Services
  • Group Day Care Home
  • Mobile Programs
  • Non-Secure Residential Services
  • Outdoor Program
  • Private Children and Youth Agency
  • Residential Child Care Facility
  • Secure Care Program
  • Secure Detention Facilities
  • Supervised Independent Living Program
  • Transitional Living Program
  • Secure Residential Services

  • Assertive Community Treatment (ACT)
  • Community Residential Rehabilitation Service
  • Crisis Intervention Programs
  • Family Based Services
  • Intensive Behavioral Health Services
  • Long-Term Structured Residence
  • Partial Hospitalization
  • Peer Support
  • Private Psychiatric Hospital
  • Psychiatric Rehabilitation Facility
  • Psychiatric Unit
  • Residential Treatment Facilities Adults

Electronic Payment of Licensing Fees

The Office of Developmental Programs (ODP)

ODP requires a certificate fee to be paid by for-profit providers before a Certificate of Compliance can be issued.  A fee letter will be issued with instructions on how to submit payment if a fee is required. Please do not submit payment prior to receiving the fee letter.

Regulation ChaptersTypes of Service DescriptionCertificate of Compliance/License FeeLink to make payment of fees
2380-Adult Training Facility,Based on amount specified on each individual fee letter 
2390-Vocational Services, Based on amount specified on each individual fee letter 
6400-Community Living Home, Based on amount specified on each individual fee letter 
6500-Family Living Home, Based on amount specified on each individual fee letter 
6600-Intermediate Care Facilities for Individuals with an Intellectual DisabilityBased on amount specified on each individual fee letter 

The Office of Mental Health and Substance Abuse Services (OMHSAS)

OMHSAS requires a fee from certain for-profit providers before a Certificate of Compliance can be issued.  A fee letter will be issued with instructions on how to submit payment if a fee is required. Please do not submit payment prior to receiving the fee letter.

Regulation ChapterType of Service DescriptionCertificate of Compliance/LicenseLink to make payment of fees
Article X Section 1001 & OMHSAS Bulletin 0803Assertive Community Treatment, Based on amount specified on each individual fee letter 
Article X Section 1001 & 5100 Mental Health Procedures  (Residential Treatment),Based on amount specified on each individual fee letter 
Article X Section 1007Peer Support Services, Based on amount specified on each individual fee letter 
5200Crisis Intervention, Based on amount specified on each individual fee letter 
5210Psychiatric Outpatient Clinics,Based on amount specified on each individual fee letter 
5230Partial Hospitalization, Based on amount specified on each individual fee letter 
5240Psychiatric Rehabilitation Services,Based on amount specified on each individual fee letter 
5300Intensive Behavioral Health Services,Based on amount specified on each individual fee letter 
5320Private Psychiatric Hospitals (Inpatient), Based on amount specified on each individual fee letter 
 Requirements for LongTerm Structured Residence LicensureBased on amount specified on each individual fee letter 

 

The Office of Long-Term Living / Bureau of Human Services Licensing (OLTL/BHSL)

OLTL/BHSL requires all providers to submit an application fee when the renewal application is due for Personal Care Homes and Assisted Living Residences.  The amount due is included with the renewal application packet issued 130 days prior to the expiration date of the current Certificate of Compliance.

For an Assisted Living Residence, a per bed fee is also required prior to the issuance of the renewal Certificate of Compliance.  A fee letter will be issued with instructions on how to submit payment if a fee is required. Please do not submit the per bed fee payment prior to receiving the fee letter.

Regulation ChapterType of Service DescriptionCertificate of Compliance/LicenseLink to make payment of fees
2600Personal Care Homes (PCH)

Renewal – All legal entities

Renewal application fee due upon submission.

 
####Personal Care Homes (PCH)

Initial application fee

The initial application cannot be made electronically.

Only a check or money order is accepted with the initial application. 
2800Assisted Living Homes (ALR)

Renewal – All legal entities

Renewal application fee due upon submission.

Per bed fee due only upon receipt of fee request letter.

 
####Assisted Living Homes (ALR)

Initial application fee

The initial application cannot be made electronically.

Only a check or money order is accepted with the initial application.

OLTL/BHSL may issue Enforcement Actions to a provider for noncompliance of the regulations.  If a fine is assessed, an invoice will be issued to the licensee.  The amount of the fine will vary depending on the penalty for the violation.  The amount due and the due date will be on each invoice.  If a fine is assessed, the licensee has the right to appeal the action.  The appeal fee will be identified in the letter accompanying the invoice. 

Regulation ChapterType of Service DescriptionFINES AND APPEALSLink to make payment of fees
2600

Personal Care Homes (PCH) 
FINES & APPEALS

Assessed with Enforcement Action 

Assessed with Enforcement Action with an Invoice or Notice.

Based on amount specified on each individual invoice or notice.

 

What Facilities Do Not Use the HS 633 Form?

Child Care Facilities

The Office of Child Development and Early Learning (OCDEL) does not utilize the HS 633. Please visit the Early Childhood Education webpage for more information.

  • Child Care Centers
  • Group Child Care Homes
  • Family Child Care Homes

Intellectual & Developmental Disabilities Services

The Office of Developmental Programs (ODP) does not utilize the HS 633. Please visit My ODP for more information.

  • Community Homes for individuals with Intellectual Disabilities (Adult Residential Services)
  • Family Living Homes
  • Adult Training Facilities
  • Vocational Facilities