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Community Services Licensure and Certification

Provider Standards Feedback Form

This form collects issues with the standards applicable to home and community-based providers that are regulated by the Arkansas DHS Division of Provider Services and Quality Assurance. The form is used to collect feedback on existing standards applicable to providers and what may need to be addressed in the future.

The form should not be used to report complaints about a provider, incidents or accidents related to a provider, adult or child maltreatment, or any other purpose.

Title Type
Provider Standards Feedback Form WEB

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Title Type
Adult Day Care (ADC) PDF
Adult Developmental Day Treatment (ADDT) PDF
Adult Day Health Care (ADHC) PDF
ARChoices Provider Certification Application PDF
Assisted Living Facility (ALF) PDF
Community Support Systems Provider (CSSP) PDF
Early Intervention Day Treatment (EIDT) PDF
Independently Licensed Practitioner (ILP) PDF
Partial Hospitalization PDF
Post Acute Head Injury (PAHI) PDF
Residential Care Facility (RCF) PDF
Targeted Case Management Provider Application PDF
Therapeutic Communities PDF


Title Type
BHA Accreditation Release Form 200 DOC
BHA Adding New Site Certification Form 250 DOC
BHA Notification Form 220 DOC
BHA Summary Form 210 DOC
SA Licensure Site Information DOC


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Arkansas Department of Human Services
Arkansas Department of Human Services

Arkansas Department
of Human Services
(501) 682-1001

TTY: 1-800-285-1131 or dial 711 for Arkansas Relay Service

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