Prior Approval Review
Sample Letter of Intent – EZ PAR or Comprehensive PAR Projects Involving an Existing Licensed Program
Letter of Intent
To:
Local Government Unit
Office of Mental Health Field Office
Office of Mental Health Field Office
From:
Agency name
Agency address
Agency address
For EZ PAR or Comprehensive Prior Approval Review (PAR) projects involving an existing licensed program, provide operating certificate number, program name:
Cert #:
Name of Program:
Proposed Action: Identify type of project
Narrative: Please provide a brief description of proposed action, identifying the county/borough involved and include anticipated effective date.
Circle type of application to be submitted: EZ PAR / Comprehensive PAR
Chief Executive Officer (CEO)/Executive Director:
Contact Person: name & title
Telephone #:
Email address:
Comments or questions about the information on this page can be directed to the Bureau of Inspection and Certification.