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03/04/2019PRINTED: DEPARTMENT OF HEALTH AND HUMAN SERVICESFORM APPROVEDCENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES(X1) PROVIDER/SUPPLIER/LIGAND PLAN OF CORRECTIONIDENTIFICATION

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How to fill out residential licesure survey

01

Begin by carefully reviewing the residential license survey form to understand what information is required.

02

Gather all necessary documentation related to your residence, such as proof of ownership or lease agreement.

03

Start by providing your personal details, including your full name, contact information, and mailing address.

04

Next, fill out the section that pertains to your residence's details, including the type of property, number of units, and square footage.

05

Provide information about any additional buildings or structures on the property, such as garages or sheds.

06

If applicable, indicate whether your residence has any attached or detached rental units.

07

In the next section, answer questions regarding the condition and safety features of your residence, such as smoke detectors or fire alarms.

08

If any repairs or maintenance are needed, make note of them in the appropriate section.

09

If you have any specific concerns or issues related to your residence, use the provided space to provide additional details.

10

Finally, review all the information you have provided and make any necessary corrections or adjustments.

11

Sign and date the residential license survey form, indicating your confirmation and agreement with the provided information.

12

Submit the completed form to the appropriate authority or organization as instructed.

Who needs residential licesure survey?

01

Anyone who owns or is responsible for a residential property may need to fill out a residential license survey.

02

This can include homeowners, landlords, property managers, or tenants depending on the requirements set by local authorities or organizations.

03

The residential license survey is typically required to ensure that the property meets certain safety and compliance standards.

04

It may also be necessary for new construction, property renovations, or change of ownership.

05

The exact need for a residential license survey can vary depending on local regulations and the specific circumstances of the property.

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