Prior Approval Review
Sample Letter of Intent
Agency Provides Mental Health Services, but Not Licensed by OMH
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 projects proposed by an agency that currently provides mental health services authorized (but not licensed) by OMH.
Identify type of services:
Proposed Action: Identify type of project
Narrative: Please provide a brief description of proposed project, identifying the county/borough involved and include anticipated effective date.
Circle type of application to be submitted: EZ Prior Approval Review (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.