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Office of Mental Health

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Prior Approval Review
Sample Letter of Intent – EZ PAR or Comprehensive PAR Projects Involving an Existing Licensed Program

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Letter of Intent

To:
Local Government Unit
Office of Mental Health Field Office
From:
Agency name
Agency address

For EZ PAR or Comprehensive Prior Approval Review (PAR) projects involving an existing licensed program, provide operating certificate number, program name:

Cert #:

Name of Program:

Proposed Action: Identify type of project

Narrative: Please provide a brief description of proposed action, identifying the county/borough involved and include anticipated effective date.

Circle type of application to be submitted: EZ 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.