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Adult Day Service

Applications, Requirements & Fees

Initial Licensure Requirements – read Title 175 NAC 5-003.01

Stage 1: Submit to the Department a complete application as required at 175 NAC 5-003.01A  and 5-003.01B.  For facilities which meet the “new construction” definition at 5-002, see additional paperwork requirements on the Department’s Facility Construction webpage.
Stage 2: Pass an onsite inspection as required at 175 NAC 5-005 & submit a Completion Certificate form completed by a Nebraska-licensed architect or engineer which documents compliance by the ADS facility with 175 NAC 5-007.
Prior to submitting an initial licensure application, the application must be complete AND the applicant should be ready to operate, but not be operating. The ADS Administrator and back-up Administrator, who meet the requirements at 175 NAC 5-006.02, must be prepared to demonstrate during the Department’s onsite inspection how the ADS will comply with the requirements at 175 NAC 5-006 & 5-007 through the use of organizational charts, job descriptions, policies, procedures, forms, and similar items along with a physical inspection of the ADS facility prior to the applicant being issued a license by the Department.
The following application must be printed, completed, signed, and mailed to our office.
Renewal Licensure Requirements – read Title 175 NAC 5-003.02
Stage 1: Department mails to licensee a notice of expiration & renewal application.
Stage 2: Licensee returns to the Department the renewal application with correct owner signatures, owner titles, dates, renewal fee, and additional items as required at 175 NAC 5-003.02A.
Stage 3: Department mails to licensee an updated license card after a complete renewal  application is received.
For a Renewal Licensure Application, please call 402-471-4967.
FeesTitle 175 Chapter 5 Regulations Governing Licensure of Adult Day Service
5-004.10 Fees: The licensee must pay fees for licensure and services as set forth below:
  1. Initial and renewal licensure fees for an ADS are:
    a. Programs with license capacity of 4-16 $200
    b. Programs with license capacity of 17-50 $250
    c. Programs with license capacity of 51 and up $300
  2. Duplicate license: $10
  3. Refunds for denied applications:
    a. If the Department did not perform an inspection, it must refund the license fee except for an administrative fee of $25.
    b. If the Department performed an inspection, the fee is not refunded.

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