DAL 18-02: Special Needs Assisted Living Residence Waiver Form DOH-5257
January 22, 2018
DAL 18-02 Special Needs Assisted Living Residence Waiver Form DOH-5257
Dear Administrator:
The purpose of this letter is to inform you that the Division of Adult Care Facility and Assisted Living Surveillance has developed a new waiver request form, specifically designed for Assisted Living Residences that are seeking additional certification as a Special Needs Assisted Living Residence (SNALR). The waiver request form was developed to streamline the waiver request and approval processes and eliminate the need for an applicant or entity to submit individual waiver request forms for each regulation that the New York State Department frequently receives with SNALR applications. The new waiver form is available as an enclosure to this letter and is posted on the Department of Health's website under ACF forms at the following link: http://www.health.ny.gov/facilities/adult_care/forms.htm.
Please be reminded that the Adult Care Facility Waiver Request/Equivalency Notification Form (DOH-5257) must be filled out in its entirety, and submitted to your Regional Office for processing.
| Patricia Hasan Capital District Regional Office 875 Central Avenue Albany, NY 12206 (518) 408-5287 |
John VanDyke Central New York Regional Office 217 South Salina Street, 4th floor Syracuse, NY 13202 (315) 477-8472 |
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| Bobbie Barrington Metropolitan Area Regional Office 90 Church Street, 15th Floor New York, NY 10007 (212) 417-4440 |
Norine Nickason Western Regional Office 335 East Main Street, 1st Floor Rochester, NY 14604 (585) 423-8185 |
Thank you for your ongoing cooperation with our efforts to improve the licensure and certification processes.
Sincerely,
Valerie A. Deetz
Director Division of Adult Care Facility and Assisted Living Surveillance
