Adult foster care licensing for new providers & licensees

Please complete the following:

• Read the Sourcewell Orientation Licensing Letter (PDF)

• Review the Adult Foster Care & Community Residential Setting Licensing Requirements (PDF)

• Study Rule 203

Adult Foster Care (AFC) Applicant Packet

• AFC Provider Process Template (PDF)

• Family AFC Application (PDF)

• Supplement Form (PDF)
  Save the PDF to your computer to access the fillable form.

• Social History Form - Adult (PDF)

• Social History Form - Child (PDF)

• Data Collection Form (PDF)
  Complete for all household members 13 and older

Community Residential Setting (CRS) Applicant Packet

Those interested in a CRS license should email licensing@sourcewell-mn.gov.
Please include county of residence in your communication.

• CRS Provider Process Template (PDF)

• CRS Licensing Application (PDF)

Once applicant packet has been received, a Sourcewell licensing specialist will initiate the licensing process beginning with background studies and Fire Marshal request.

A regional licensing specialist will bring and review the following documents at your initial in-person inspection:

• DHS - Workers Compensation Certification (PDF)

• DHS - Notice of Privacy Practice Signature (PDF)

• DHS - Vulnerable Adult Act (PDF)

• PAPP: Program Abuse Prevention Plan (PDF)

• Program plan (PDF)

• Fire escape plan (PDF)

• Emergency response plan and procedures (DOC)

• DHS - CRS with 245D/HCBS Licensing Checklist (PDF)

• DHS - Home Safety Checklist (PDF)

• DHS - Vulnerable Adult Mandated Reporting Policy (PDF)

• Drug and Alcohol Policy (DOC)

• Grievance Procedure (PDF)

• Staff training record (PDF)

• Service Termination Policy (Elderly Waiver) (PDF)

• Details on developing additional policies and procedures

Once everything has been completed, your regional licensing specialist will submit the recommendation within 20 business days to DHS for licensure.

Final approval will be given by DHS.