Section He-P 808.04 - License Application Requirements(a) Each applicant for a license shall comply with the requirements of RSA 151:4II-a, I-I, and submit the following to the department, except that subparagraphs (a)(1)-(3) and (5)-(7) shall not apply to mobile laboratory vans: (1) A completed application form entitled "Application for Residential and or Health Care License (Laboratories and Collecting Stations)," (July 2023 edition) signed by the owner if a private facility, 2 officers if a corporation, 2 authorized individuals if an association or partnership, or the head of the government department if a government unit, affirming to the following: "I affirm that I am familiar with the requirements of RSA 151 and the rules adopted thereunder and that the premises are in full compliance. I understand that providing false information shall be grounds for denial, suspension, or revocation of a license, or imposition of a fine.";
(2) A floor plan of the prospective laboratory;(3) If applicable, proof of authorization from the New Hampshire secretary of state to do business in the state of New Hampshire in the form of one of the following: a. "Certificate of Authority," if a corporation;b. "Certificate of Formation," if a limited liability company; orc. "Certificate of Trade Name," if a sole proprietorship;(4) The applicable fee in accordance with RSA 151:5, XXIII, payable in cash, or if paid by check or money order, in the exact amount of the fee and made payable to the "Treasurer, State of New Hampshire";(5) A resume identifying the qualifications, and copies of applicable licenses, for the administrator and laboratory director;(6) Written local approvals as follows:a. For an existing building, the following written local approvals shall be obtained no more than 90 days prior to submission of the application, from the following local officials, or if there is no such official(s), from the board of selectmen or mayor:1. The health officer verifying that the applicant complies with all applicable local health requirements and drinking water and wastewater requirements;2. The building official verifying that the applicant complies with all state building codes and local building ordinances;3. The zoning officer verifying that the applicant complies with all applicable local zoning ordinances; and4. The fire chief verifying that the applicant complies with the state fire code and any local ordinances; andb. For a building under construction, the written approvals required by a. above shall be submitted at the time of the application based on the local official's review of the building plans and again upon completion of the construction project;(7) If the laboratory uses a private water supply, documentation that the water supply has been tested in accordance with RSA 485 and Env-Dw 702.02, Env-Dw 704.02, or, if a public water supply is used, a copy of a water bill;(8) The results of a criminal records check for the applicant, the licensee, if different than the applicant, the laboratory director, and the administrator, as applicable. The results must include criminal history from the state of New Hampshire; and(9) List of all tests performed and a copy of the CLIA certificate.(b) The applicant shall mail or hand deliver the documents to: Department of Health and Human Services
Health Facilities Administration
129 Pleasant Street
Concord, NH 03301
N.H. Admin. Code § He-P 808.04
#2192, eff 11-25-82; ss by #3193, eff 1-28-86; ss by #5317, EMERGENCY, eff 1-29-92, EXPIRED: 5-28-92
New. #5758, eff 12-20-93, EXPIRED: 12-20-99
New. #8409, eff 8-19-05; ss by #8852, eff 3-24-07; ss by #10267, eff 2-2-13
Amended by Number 37, Filed September 14, 2023, Proposed by #13710, Effective 8/2/2023, Expires 8/2/2033