Licensing Checklist for Residential Facilities for Groups (AGC)

Licensure Application Information

The link below will take you to the system where you can create an account to apply for a new facility or a Change of Ownership (CHOW).

If you already have an existing license and you are just making a change to your license, you can use this system to apply for any of the following:

and more...

For all initial/CHOW licensure applications the following items are required to be uploaded to your application:

Provide a Copy of Current Elder Abuse, Neglect, and Exploitation Training for the Administrator
- Find the training here: http://dpbh.nv.gov/Reg/HealthFacilities/Training___Education/

Copy of Nevada State Business license from the secretary of state office with your NV ID number

Only the Copy of the license will be accepted. No receipts or screenshots from SilverFlume.
Must list your registered name with the secretary of state listed in your application.
Must list your NV business ID with the secretary of state listed in your application.

Should include information about the buyer and seller, the date of the sale, a description of the transaction, the price, and signatures from both parties.

Letter of Governing Body stating the effective date of change and specifying what is changing (CHOW only)

All Licensed facilities must have a physical location in the State of Nevada.
Must list your facility name, facility physical address, proof that you are allowed to run the facility from that location, and must be fully executed.

Must list your LLC name, the names of the officers, and the Nevada Business ID number.

Articles of incorporation (for corporations only)
- Must list your corporation's name, the names of the officers, and the Nevada Business ID number.

Provide either the owner(s) resume proving 3 years of owning the same type of facility
Or if that doesn't apply, provide the resume and 1 letter of reference for each owner.

Must list facility name and physical address in the "Insured" box
Must have insurance complete the occurrence and amount information.
Must have "certificate holder" box list the Division of Purchasing and Compliance 727 Fairview Drive, Suite E, Carson City, NV 89701.

Surety bond
- Must be indebted to the State of Nevada, Department of Human Services, Aging and Disability Services.
- Must list the facility's doing business as (DBA) name and physical address of the facility listed on the top.
- Must have the full physical address of the facility on the bottom right.
- Must be signed by the principal/owner.
- Must be original seal/stamp on the surety bond from the bond company.
- Per NRS 449.065, the bond must be $5,000 if you have fewer than 7 employees, $25,000 for 7-24 employees, $50,000 for more than 25 employees.

Copy of (Local - City or County) Business License, Conditional Use Verification Form, Zoning Approval Letter, or Special Use Permit from the local, city or county Jurisdiction.
- Payment receipts do not meet this requirement and will not be accepted.
- The local license must list your Doing Business As (DBA) facility name and physical location of the facility.

Certificate of Compliance (CofC) from the NV State Fire Marshall (SFM).
- State personnel will send a facility inspection request to the SFM once you have uploaded all of the required checklist items to your application. You will be required to upload the CofC to your application once received from the SFM.

The first and last name on this document must match with the name in your application.
Must have the facility's doing as business (DBA) name on it.
Must list the exact bed count that is listed in your application.

Application attachment to select license endorsement.
- This form will be provided after submitting your application.