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DEPARTMENT OF HEALTH SERVICES Division of Quality AssuranceF03082D (08/2022) STATE OF WISCONSIN SUBSTANCE USE TREATMENT PROVIDER INITIAL CERTIFICATION (or) CHANGE OF OWNERSHIP APPLICATION DHS 75.60
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How to fill out initial certification or change

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Obtain the necessary forms from the relevant department or agency
02
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03
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04
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Who needs initial certification or change?

01
Individuals or organizations who require official certification or need to make a change to their existing certification

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Initial certification or change is a process of submitting necessary documentation to confirm compliance with regulations or to update information.
Individuals or entities mandated by law or regulations to report changes or submit initial certification documents are required to file.
You can fill out the initial certification or change forms provided by the relevant regulatory authority with accurate information.
The purpose of initial certification or change is to ensure compliance with regulations, update information, and maintain transparency.
The information required to be reported on initial certification or change may include personal or business details, financial information, and any changes in operations.
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