Submission of this request in no way obligates the requester or applicant to open a health facility/agency.. The information submitted allows the Division to track the number of proposed facilities, efficiently handle application requests and to eliminate unnecessary mailings of information packets. Please provide the requested information to the best of your knowledge. If a question is not applicable or is unknown at the time of request, please write “N/A” or “Unknown” where appropriate.
PLEASE NOTE: This for is for new/initial license LOIs, some new/initial certifications, and change of ownership (CHOW) LOIs only.
If you are an existing health facility or agency with an active license, you must use the Update Application option available through your Licensing Workbench on the Colorado Health Facilities Interactive (COHFI) site to report all changes. Do not use this form.
