Licensing Checklist for Employment Agency to Provide Nonmedical Services (PCE)

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.

Personal references and information concerning the applicant's financial status and business activities and association in and out of the State during the immediately preceding 3-year period. If the applicant is a firm, association, organization, partnership, business trust, corporation or company, such references and information must be provided with respect to the members thereof and the person in charge of the facility or program.

Full, complete and accurate information regarding the ownership of the facility or program and all changes to that ownership that occur while the application is pending. The information must include the name of
- (1) Each natural person who is an owner of the facility or program;
- (2) Each person who has a direct ownership interest in the facility or program of 10% or more and who is the owner, in whole or in part, of any mortgage, deed of trust, note or other obligation secured in whole or in part by the facility or program or any of the property or assets of the facility or program;
- (3) If the applicant is a corporation, each officer and director; and
- (4) If the applicant is a partnership, each partner.
High school of diploma or equivalent for Administrator
- A United States high school diploma or equivalent (like a GED)
- Must go through NACES if a foreign diploma

Government-issued Identification: Documents like driver's license or state ID cards can serve as proof of age.

A copy of the certificate of occupancy, a copy of the applicant's business license and a copy of any special use permits obtained in connection with the operation of the facility or program.

Evidence satisfactory to the Division that the facility or program meets all applicable federal, state and local laws and complies with all safety, health, building and fire codes. If there are any differences between the state and local codes, the more restrictive standards apply.

If required by NRS 439A. 100, a copy of a letter of approval issued by the Director of the Department of Health and Human Services.
- NRS 439A.100 Approval of Director required for certain projects; criteria for review of application.
  - Except as otherwise provided in this section, in a county whose population is less than 100,000, or in an incorporated city or unincorporated town whose population is less than 25,000 that is located in a county whose population is 100,000 or more, no person may undertake any proposed expenditure for new construction by or on behalf of a health facility in excess of the greater of $2,000,000 or such an amount as the Department may specify by regulation, which under generally accepted accounting principles consistently applied is a capital expenditure, without first applying for and obtaining the written approval of the Director. The Division of Public and Behavioral Health of the Department shall not issue a new license or alter an existing license for such a project unless the Director has issued such an approval.