PDF
Word
This version of the form is not currently in use and is provided for reference only. Download this version of
the document
for the current year.
Application for License to Operate an Assisted Living Home: Household Member Worksheet - Alaska
Application for License to Operate an Household Member Worksheet is a legal document that was released by the Alaska Department of Health and Social Services - a government authority operating within Alaska.
FAQ
Q: What is the purpose of the Household Member Worksheet?A: The Household Member Worksheet is used to gather information about the individuals residing in the assisted living home.
Q: Who needs to fill out the Household Member Worksheet?A: The licensee or applicant for a license needs to complete the Household Member Worksheet.
Q: What information is required on the Household Member Worksheet?A: The Household Member Worksheet requires information such as name, age, relationship to the licensee, and criminal history.
Q: Why is criminal history information required?A: Criminal history information is required to ensure the safety and well-being of residents in the assisted living home.
Form Details:
- Released on September 9, 2019;
- The latest edition currently provided by the Alaska Department of Health and Social Services;
- Ready to use and print;
- Easy to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the Alaska Department of Health and Social Services.
