Section Plc 503.02 - Requests to Approve Other Providers(a) Any person who believes that an entity that is not listed in Plc 503.01 as an approved provider meets the standards in Plc 503.04 may request the executive director to approve the entity as an approved provider.(b) The person requesting approval shall provide the following information to the executive director in writing: (1) The requestor's name, mailing address, daytime telephone number, and email address;(2) The requestor's relationship with the entity, such as a member of the entity's board of directors or an individual who is otherwise affiliated with the entity;(3) The full formal name of the entity as shown on the documents that created the entity, and each name under which the entity does business;(4) The entity's mailing address and the address of the entity's physical location in New Hampshire;(5) The legal form of the entity, such as a corporation or partnership, the jurisdiction in which the entity was formed, and the month and year of the entity's formation;(6) For any entity formed in a jurisdiction other than New Hampshire, the date on which the entity became authorized to do business in New Hampshire;(7) The URL of the entity's website;(8) Whether the entity is a parent or subsidiary of, or is otherwise legally affiliated with, any organization that provides treatment or rehabilitation services, and if so the full legal name of each such organization and the specific relationship to the entity seeking approval; (9) Whether the entity wants to be an approved provider for all regulated professions or only certain regulated professions, and if the latter, the profession(s) for which the entity wants to be an approved provider;(10) An explanation of the entity's qualifications and resources which clearly demonstrates that the entity meets the standards specified in Plc 503.04; and(11) Any other information the requestor believes is relevant to the request.(c) The person submitting the request shall sign and date the request.(d) The signature provided pursuant to (c), above, shall constitute certification that: (1) The information provided is true, complete, and not misleading to the best knowledge and belief of the signer; and(2) The signer has been duly authorized by the entity to submit the request.N.H. Admin. Code § Plc 503.02
Derived from Number 24, Filed June 13, 2024, Proposed by #13971, Effective 7/1/2024, Expires 7/1/2034.