PDF
Word
This version of the form is not currently in use and is provided for reference only. Download this version of
DSHS Form 06-169
for the current year.
DSHS Form 06-169 Afh Change in Licensed Bed Capacity - Decrease - Washington
What Is DSHS Form 06-169?
This is a legal form that was released by the Washington State Department of Social and Health Services - a government authority operating within Washington. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is DSHS Form 06-169?
A: DSHS Form 06-169 is a form used for notifying the Department of Social and Health Services (DSHS) in Washington State about a decrease in licensed bed capacity in an Adult Family Home (AFH).
Q: What is an Adult Family Home (AFH)?
A: An Adult Family Home (AFH) is a residential home in Washington State that provides care and support services to aging or disabled adults.
Q: When should DSHS Form 06-169 be used?
A: DSHS Form 06-169 should be used when there is a decrease in the number of licensed beds in an Adult Family Home (AFH) in Washington State.
Q: Why is it important to notify DSHS about a decrease in licensed bed capacity?
A: It is important to notify DSHS about a decrease in licensed bed capacity because it ensures that the AFH is operating within the permitted limit and can continue to provide quality care to its residents.
Q: How can DSHS Form 06-169 be submitted?
A: DSHS Form 06-169 can be submitted electronically or by mail to the designated DSHS office.
Q: Are there any fees associated with submitting DSHS Form 06-169?
A: No, there are no fees associated with submitting DSHS Form 06-169.
Q: What information is required on DSHS Form 06-169?
A: DSHS Form 06-169 requires information such as the AFH provider's name, license number, current bed capacity, proposed bed capacity, and the effective date of the change.
Q: Are there any additional documents that need to be submitted with DSHS Form 06-169?
A: No, there are no additional documents that need to be submitted with DSHS Form 06-169, unless specifically requested by DSHS.
Q: What happens after submitting DSHS Form 06-169?
A: After submitting DSHS Form 06-169, DSHS will review the form and make a determination. The provider will be notified of the decision in writing.
Q: Is it possible to appeal DSHS's decision regarding a decrease in licensed bed capacity?
A: Yes, it is possible to appeal DSHS's decision regarding a decrease in licensed bed capacity. The provider will receive instructions on how to appeal if the request is denied.
Form Details:
- Released on August 1, 2016;
- The latest edition provided by the Washington State Department of Social and Health Services;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a printable version of DSHS Form 06-169 by clicking the link below or browse more documents and templates provided by the Washington State Department of Social and Health Services.
