Form CDPH276D Disclosure of Ownership and Control Interest Statement - California

What Is Form CDPH276D?

This is a legal form that was released by the California Department of Public Health - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is the CDPH276D form?
A: The CDPH276D form is the Disclosure of Ownership and Control Interest Statement in California.

Q: What is the purpose of the CDPH276D form?
A: The purpose of the form is to disclose the ownership and control interests of individuals or entities in a healthcare facility in California.

Q: Who needs to file the CDPH276D form?
A: The owners or controlling persons of a healthcare facility in California need to file the CDPH276D form.

Q: What information is required in the CDPH276D form?
A: The form requires information such as the name and address of owners or controlling persons, percentage of ownership or control interest, and any criminal history.

Q: Is there a fee for filing the CDPH276D form?
A: Yes, there is a fee associated with filing the CDPH276D form. The fee amount may vary.

Q: When should the CDPH276D form be filed?
A: The CDPH276D form should be filed within 30 days of a change in ownership or control interest of a healthcare facility.

Q: What happens if I fail to file the CDPH276D form?
A: Failure to file the CDPH276D form may result in penalties or legal consequences, and could affect the licensing or operation of the healthcare facility.