Frequently Asked Questions – AFH Application
Application Requirements
What are some of the application requirements that I must meet to be licensed as an adult family home provider?
$2,750 fee must be turned in with the license application;
For a change of ownership (CHOW) for a currently licensed AFH, submit a written letter from the current licensee saying that they are willing to give up their license when and if your license is approved;
Copy of your AFH Orientation Certificate taken within the last 12 months;
Copy of Washington State Business License Number showing the Unified Business Identifier or UBI;
Copy of document issued by the Internal Revenue Service (IRS) verifying the Employer Identification Number or EIN (Federal Tax ID Number);
Copies of documents showing that the applicant provider, entity representative, and resident manager meet the minimum qualifications for licensure including: educational requirements, CPR certificate, first-aid card, TB screening test, and long-term care worker training and Home Care Aide Certificate;
Meet the minimum education requirements that include a High School Diploma or GED, or any English-translated government document listed in WAC 388-76-10130;
Completed Caregiving Experience Attestation Form verifying (proving) that you successfully completed 1000 hours of direct caregiving experience to a non-family member in the previous 60 months. This experience must be obtained after you were 18 years of age, and is only applicable if care was to vulnerable adults in a licensed or contracted setting.
Certification for completing 48-hour Administrator training before applying for an AFH license;
Copies of specialty training documents if you intend to care for residents with dementia, developmental disabilities, or mental illness;
Completed Background Inquiry Authorization Forms for all providers, resident care managers, and all members of the household that are eleven years of age or older and others who will have unsupervised access to your residents;
Copy of the completed AFH Building Inspection indicating “Passed” with the adult family home floor plan and printed directions to the AFH;
A copy of your AFH admission agreement or private pay and Medicaid-eligible residents;
A copy of the disaster plan; including the applicant’s or entity representative’s name and the name of the proposed adult family home;
A copy of your nurse delegation certificate if you plan to perform delegated nursing tasks;
Be 21 years of age or older and be able to understand and speak English; and
A completed application and checklist – the department will not process your application if it is not complete.
