Section He-C 6343.11 - Application Process For Payment Standards For Private Vehicle Transportation Services(a) Individual applicants who seek initial certification for the provision of private transportation services shall contact a DCYF district office supervisor or designee and request to be referred for certification.(b) The DCYF district office supervisor or DCYF community, family, and program support certification specialist shall assess the need for services, based on the following criteria: (1) The number of children and families who require services exceeds the available community resources;(2) A specialized service is necessary to meet the unique needs of children and families, and there are no currently certified providers who can provide the specialized service; or(3) Any other case circumstance which requires the provision of services pursuant to a court order.(c) If there is a need for a service based on (b) above, DCYF shall forward an application packet to the applicant which includes: (1) Form 2615 "Application for Certification and Enrollment of Private Vehicle or Educational Transportation Service Providers";(2) A "State of New Hampshire Alternate W-9";(3) A NH department of safety, division of state police Form DSSP 256 "Criminal History Record Information Release Authorization Form" for the provider unless the provider is a licensed foster care provider;(4) A Form 2503 "DCYF Central Registry Name Search Authorization" for the provider unless the provider is a licensed foster care provider; and(d) Each applicant shall complete and submit Form 2615 "Application for Certification and Enrollment of Private Vehicle or Educational Transportation Service Providers" (March 2019) to DCYF within 30 days of receipt, together with all the attachments in He-C 6343.11(g) .(e) Each applicant shall sign and date Part C: "Applicant Information" of Form 2615 "Application for Certification and Enrollment of Private Vehicle or Educational Transportation Service Providers" (March 2019) certifying the following: "I declare that all the information contained above is true, correct and complete to the best of my knowledge and belief. I acknowledge that the provision of false information in the application is a basis for denial of the application."
(f) Each applicant shall sign and date Part D: "Authorization/Statement of Understanding" of Form 2615 "Application for Certification and Enrollment of Private Vehicle or Educational Transportation Service Providers" (March 2019) certifying the following: "I have reviewed the Administrative Rule He-C 6343, Certification for Payment Standards for Transportation Service Providers and will adhere to the rules as a certified provider. I authorize the NH Division for Children, Youth and Families (DCYF) to conduct a certification for payment review to determine the program's compliance with Administrative Rule He-C 6343, Certification for Payment Standards for Transportation Service Providers. I further understand that DCYF has the right to verify information contained in this application.
The information contained in this application is correct to the best of my knowledge. I acknowledge that the provision of false information in the application is a basis for denial of the application."
(g) Each applicant shall submit the following with Form 2615 "Application for Certification and Enrollment of Private Vehicle or Educational Transportation Service Providers" (March 2019): (1) A completed "State of New Hampshire Alternate W-9" (October 2016);(2) A completed and notarized Form 2503 "DCYF Central Registry Name Search Authorization", (February 2017) or Authorization for DCYF to obtain. This will not be required if the applicant is currently licensed as a foster care provider under He-C 6347;(3) A completed NH department of safety, division of state police DSSP 256 "Criminal History Record Information Release Authorization Form" This will not be required if the applicant is currently licensed as a foster care provider under He-C 6347; and(4) A copy of the provider's motor vehicle record from the NH department of safety, division of motor vehicles.N.H. Admin. Code § He-C 6343.11
(See Revision Note at part heading for He-C 6343) #9390, eff 3-1-09
Amended by Volume XXXIX Number 06, Filed February 7, 2019, Proposed by #12592, Effective 7/26/2018, Expires 1/22/2019.Amended by Volume XXXIX Number 16, Filed April 18, 2019, Proposed by #12750, Effective 3/26/2019, Expires 3/26/2029.