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Forms and Applications

Application Forms

Form 1: Letter of Intent

Submit Letter of Intent online - Pursuant to 900 KAR 6:090, the online Letter of Intent must be submitted no later than 4:30 p.m. Eastern time on the date it is due.

Form 2A: Application for substantive review and regulatory non-substantive review excluding ambulances

Form 2B: Application for Ambulance Providers

Form 2C: Application for Change of Location, Cost Escalation or the Replacement of a Facility

Public Hearing Documents

Notice: 900 KAR 6:090 Section 3 has been amended to modify rules for submitting public hearing documents such as the notices of appearance and exhibit and witness lists. Each of these documents must be submitted at least five calendar days prior to any scheduled nonsubstantive review hearing date and at least seven calendar days prior to date of all other scheduled hearings.

Form 3: Notice of Appearance

Form 4: Witness List

Form 5: Exhibit List

Miscellaneous Forms

Form 6: Cost Escalation Form

Form 7: Request for Advisory Opinion

Form 9: Notice of Intent to Acquire a Health Facility or Health Service

Form 10A: Notice of Addition of Health Service or Equipment

Form 10B: Notice of Termination or Reduction of a Health Service or Reduction of Bed Capacity

Form 11: Application for a Certificate of Compliance for a Continuing Care Retirement Community (CCRC)


Last Updated 5/28/2015