Our goal is to help you feel as prepared as possible for your relicensing visit. Please reach out to your Regional Licensing Specialist RLS) if you have any questions about the requirements. You will receive an email from your RLS approximately 2 months in advance of your license expiration to schedule your visit. Please return documents in advance via email.  

Any document with a Sourcewell logo is an optional template. You may use a company form or template if you wish as long as all requirements are met. DHS branded documents and templates should be used when available. 

Documents to review 

Your RLS will complete these documents during your relicensing visit. It’s a good idea to review these documents ahead of time to make sure you are ready. Requirements on these checklists are the minimum standards outlined in Rule of Statute to ensure resident safety and rights as well as program integrity.  

• Home Safety Checklist (PDF)
• Licensing Checklist for Community Residential Setting (PDF)

It’s also a good idea to review these additional documents to help make sure you are prepared. 

• Relicensing Letter for CRS programs (PDF)
• Overview of Ongoing Requirements (DOC)

Documents to review and/or complete 

You must complete and/or review and provide copies of the following documents to your RLS. You can return these documents via secure email or your RLS will scan the documents during the visit.  

List of home documents:

• CRS Application (PDF)
• Census and Home Information Sheet (PDF)
• Certificate of Compliance Minnesota Workers’ Compensation Form (PDF)
• Emergency Procedures (PDF)
• Escape Plan (PDF)
• Fire Drill Log (PDF)
• Program Abuse Prevention Plan (PDF)

You will be asked to complete the following forms if they apply to your home: 

• Equipment Maintenance Form (PDF)
• Pet Authorization form (PDF) and proof of rabies vaccination 
• Well water test results with safe levels of coliform and nitrates
  
  • Well Water Testing Laboratories Locations (PDF)

A change of premise happens when you move from one home to another within the same county. If you are moving near the time your license is due to be renewed, your RLS will instruct you to also complete relicensing forms. 

• The county and DSD moratorium must approve the change of premise 
• Notify your RLS to receive the request for Fire Marshal inspection 
• HCBS licensed providers: Follow any HCBS requirements for location changes 
• Ensure all documents are updated with your new address and information including: 
  • Program Abuse Prevention Plan (PDF)
  • Program Plan (PDF)
  • Application (PDF)
  • Escape Plan and Emergency Procedures (PDF)
  • Updated well water testing, if applicable
    • Well Water Testing Laboratories Locations (PDF)
• You must select a date that you want your license to update to your new address (you cannot stay with residents at the new address prior to the change or at the previous address after the change) 
• Once all documents have been received and any citations from the Fire Marshal inspection have been completed, a final walk through will be conducted by your RLS

Capacity changes and home closures must be approved by DSD moratorium.  

Capacity increases are based on several factors: 

• Moratorium bed availability 
• County need, population served 
• Bedrooms available in the home 

Capacity decreases may be submitted for long-term/permanent changes only.  

Prior to permanently closing a home, please ensure you follow Service Termination policies and procedures.  

Temporary home closures may be available on a case by case basis. These temporary closures are referred to as “pending reopening”. If approved, the home may go into an inactive status for up to 1-year. After 1-year, the home must be reopened or permanently closed.  

If you would like to request a capacity increase and have not been awarded a bed, please complete the below form: 

• Capacity Change Guidelines and Request Form (PDF)

• Fire Extinguisher Reservicing Options (PDF)
• Prescription Drug Disposal Collection Bins (PDF)
• Notification of Residential Placement (PDF)
• Ceiling Height Variance Request (PDF)