Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 5 - DEPARTMENT OF HEALTH SERVICES LOAN REPAYMENT › Article 2 - PRIMARY CARE PROVIDER LOAN REPAYMENT PROGRAM › Section R9-5-201 - Application for a License

Current through Register Vol. 30, No. 28, July 12, 2024
A.
				An applicant for a license shall:
1. Be at
				least 21 years of age;
2. If an
				individual, be a U.S. citizen or legal resident alien and a resident of
				Arizona;
3. If a corporation,
				association, or limited liability company, be a domestic entity or a foreign
				entity qualified to do business in Arizona;
4. If a partnership, have at least one
				partner who is a U.S. citizen or legal resident alien and a resident of
				Arizona;
5. Submit to the
				Department an application packet containing:
a. An application on a form provided by the
				Department that contains:
i. The applicant's
				name;
ii. The applicant's date of
				birth;
iii. The facility's name,
				street address, city, state, zip code, mailing address, and telephone
				number;
iv. The requested service
				classifications;
v. Whether the
				applicant agrees to allow the Department to submit supplemental requests for
				information;
vi. A statement that
				the applicant has read and will comply with A.R.S. Title 36, Chapter 7.1,
				Article 1 and this Chapter;
vii. A
				statement that the information provided in the application packet is accurate
				and complete; and
viii. The
				applicant's signature and date the applicant signed the application;
b. A copy of the applicant's:
i. U.S. passport,
ii. Birth certificate,
iii. Naturalization documents, or
iv. Documentation of legal resident alien
				status;
c. A copy of the
				applicant's valid fingerprint clearance card, both front and back, issued
				according to A.R.S. Title 41, Chapter 12, Article 3.1;
d. A copy of the applicant's valid background
				check document according to A.R.S. §
											46-811(A);
e. A
				copy of the form required in A.R.S. §
											36-883.02(C);
f. A
				certificate issued by the Department showing that the applicant has completed
				at least four hours of Department-provided training that included the
				Department's role in licensing and regulating child care facilities under
				A.R.S. Title 36, Chapter 7.1, Article 1, and this Chapter;
g.
				Except as provided in subsection (A)(5)(j), a site plan of the facility drawn
				to scale showing:
i. The drawing
				scale;
ii. The boundary dimensions
				of the property upon which the facility's physical plant is located;
iii. If more than one building is used for
				the facility, the location and perimeter dimensions of each building;
iv. The location of each driveway on the
				property;
v. The location and
				boundary dimensions of each parking lot on the property;
vi. The location and perimeter dimensions of
				each outdoor activity area;
vii.
				The location, type, and height of each fence and gate; and
viii. If applicable, the location of any
				swimming pool on the property;
h. Except as provided
				in subsection (A)(5)(j), a floor plan of each building to be used for child
				care services drawn to scale showing:
i. The
				drawing scale;
ii. The length and
				width dimensions for each indoor activity area;
iii. The requested licensed capacity and
				applicable service classification for each indoor activity area;
iv. The location of each diaper changing
				area;
v. The location of each hand
				washing, utility, and three-compartment sink, toilet, urinal, and drinking
				fountain; and
vi. The location and
				type of fire alarm system;
i. Except as provided
				in subsection (A)(5)(j):
i. A copy of a
				certificate of occupancy issued for the facility by the local
				jurisdiction;
ii. Documentation
				from the local jurisdiction that the facility was approved for occupancy;
				or
iii. If the documents in
				subsections (A)(5)(i)(i) and (ii) are not available, the seal of an architect
				registered as prescribed in A.R.S. §
												32-121
				on the site plan required in subsection (A)(5)(g) and the floor plan required
				in subsection (A)(5)(h) verifying compliance with current local building and
				fire codes, local zoning requirements, and this Chapter;
j. For
				an applicant providing child care services to three-year-old, four-year-old,
				five-year-old, or school-age children in a facility located in a public school,
				a set of final construction drawings or a school map showing:
i. The location of each school
				building;
ii. The location and
				dimensions of each outdoor activity area to be used by enrolled
				children;
iii. The length and width
				dimensions for each indoor activity area;
iv. The requested licensed capacity and
				applicable service classification for each indoor activity area; and
v. The location of each hand-washing sink,
				toilet, urinal, and drinking fountain to be used by enrolled
				children;
k. If the facility is located within one-fourth of a
				mile of agricultural land:
i. The names and
				addresses of the owners or lessees of each parcel of agricultural land located
				within one-fourth mile of the facility, and
ii. A copy of an agreement complying with
				A.R.S. §
												36-882
				for each parcel of agricultural land;
l. The applicable fee
				in
				R9-5-206;
m. If
				the applicant is a business organization, a form provided by the Department
				that contains:
i. The name, street address,
				city, state, and zip code of the business organization;
ii. The type of business
				organization;
iii. The name, date
				of birth, title, street address, city, state, and zip code of each controlling
				person;
iv. A copy of the business
				organization's articles of incorporation, articles of organization, partnership
				documents, or joint venture documents, if applicable;
v. Documentation of good standing issued by
				the Arizona Corporation Commission and dated no earlier than three months
				before the date of the application; and
vi. A statement signed by the applicant
				stating:
(1) That each controlling person has
				not been denied a certificate or license to operate a child care group home or
				child care facility in this state or another state, and
(2) That each controlling person has not had
				a certificate or license to operate a child care group home or child care
				facility revoked in this state or another state for endangering the health and
				safety of children;
n. If the applicant is
				a public school, a form provided by the Department that contains:
i. The name of the school district;
ii. The name, title, street address, city,
				state, and zip code of each responsible party, if the responsible party is an
				individual, or each individual in the group, if the responsible party is a
				group of individuals;
iii. A
				statement signed by the applicant stating:
(1)
				That each individual in subsection (A)(5)(n)(ii) has not been denied a
				certificate or license to operate a child care group home or child care
				facility in this state or another state, and
(2) That each individual in subsection
				(A)(5)(n)(ii) has not had a certificate or license to operate a child care
				group home or child care facility revoked in this state or another state for
				endangering the health and safety of children; and
iv. A letter from the school district
				governing board or school district superintendent designating a signatory, if
				applicable;
o. If the applicant is a charter school, a form
				provided by the Department that contains:
i.
				The name, title, street address, city, state, and zip code of each responsible
				party, if the responsible party is an individual, or each individual in the
				group, if the responsible party is a group of individuals;
ii. A statement signed by the applicant
				stating:
(1) That each individual in
				subsection (A)(5)(o)(i) has not been denied a certificate or license to operate
				a child care group home or child care facility in this state or another state,
				and
(2) That each individual in
				subsection (A)(5)(o)(i) has not had a certificate or license to operate a child
				care group home or child care facility revoked in this state or another state
				for endangering the health and safety of children; and
iii. A letter from the school district
				governing board in which the charter school is located, the Arizona State Board
				of Education, or the Arizona State Board for Charter Schools, approving the
				applicant to operate the charter school; and
p. If
				the applicant is a governmental agency, a form provided by the Department that
				contains:
i. The name, title, street address,
				city, state, and zip code of each responsible party, if the responsible party
				is an individual, or each individual in the group, if the responsible party is
				a group of individuals;
ii. A
				statement signed by the applicant stating:
(1)
				That each individual in subsection (A)(5)(p)(i) has not been denied a
				certificate or license to operate a child care group home or child care
				facility in this state or another state, and
(2) That each individual in subsection
				(A)(5)(p)(i) has not had a certificate or license to operate a child care group
				home or child care facility revoked in this state or another state for
				endangering the health and safety of children; and
iii. A letter from the individual in the
				senior leadership position with the agency designating a
				signatory.