Provisional License and Self-Declaration Document 620-01-80-01

(Revised 4/3/23 ML #3717)

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A Provisional License or Self-Declaration Document shall be issued for the operation of an initial child care for a 6-month period, if the program is unable to, show evidence of compliance to applicable standards and rules of the department at the time of licensure. This includes but is not limited to evidence of staff requirements being met.

 

An unannounced visit is required 3 months after issuance of a Provisional License or Self-Declaration Document.

 

A child care who can show evidence of compliance at 6 months shall be issued a License or Self-Declaration Document without a Provisional.

 

The Licensing Specialist, Supervisor, and Administrator will determine if a second 6-month Provisional License will be issued for a child care who is out of compliance at the end of the Provisional License or Self-Declaration document.

 

A Provisional License or Self-Declaration Document may be issued during a licensing period if the applicant or operator fails to, or is unable to, comply with all applicable standards and rules of the department.

 

Refer to Administrative Rules for more details about when the department may issue a Provisional License or Self-Declaration Document.

 

Steps for Issuing a Provisional License/Self-Declaration Document:

  1. The Licensing Specialist shall request that a Provisional License or Self-Declaration Document be issued by the Licensing Supervisor.

     

  2. The Licensing Supervisor shall prepare the Provisional Agreement and consult with the Licensing Administrator and Legal Advisory Unit before a Provisional License or Self-Declaration Document is issued.

     

  3. When the decision is made to issue a Provisional License or Self-Declaration Document:

     

    1. The approved Provisional Agreement is provided to the Licensing Specialist by the Licensing Supervisor.

       

    2. The Licensing Specialist shall go over the Provisional Agreement with the provider and send the approved Provisional Agreement to the provider.

       

    3. The Provisional Agreement must be signed by the provider and returned to the Licensing Specialist.

       

    4. The Licensing Specialist signs the Provisional Agreement and forwards the document to the Licensing Supervisor.

       

    5. The Licensing Supervisor signs the Provisional Agreement and issues the Provisional License/Self-Declaration Document.

       

    6. The word “Provisional” must be on the face of the License/Self-Declaration Document.

       

    7. The Licensing Specialist reviews the document with the provider and forwards the documents to the provider. The provider must sign the agreement and return a signed copy of the agreement to the Licensing Specialist.

       

    8. The provider must post the signed Provisional Agreement with the Provisional License/Self-Declaration Document.

       

    9. Extensions to the Provisional License/Self-Declaration Document are not permitted, however, the provider may request a new Provisional License/Self-Declaration Document.