Providers who hold a license to operate a facility licensed by the Pennsylvania Department of Human Services (DHS) are being notified of a change to the Civil Rights Compliance process. There is a new Civil Rights Compliance form when submitting a new licensing application as well as a new Civil Rights Compliance Renewal form when submitting a licensing renewal application.
Entities seeking a new license will utilize a Civil Rights Compliance (CRC) form (HS2126). The prior Civil Rights Compliance (CRC) form is now obsolete and will be returned back to providers. This form must be included in the packet submitted as part of any new license request. The new application, supporting documents, and CRC form must be emailed to the DHS office that issues your license; the email address can be found in the chart below.
Entities licensed by OCDEL or ODP who use CLS or PELICAN to submit new applications must submit the form by email. The CRC forms are not part of the electronic CLS/PELICAN new application process. The updated CRC form for new applications can be found on the DHS website under the “Application for License” page.
For licensing renewals, a licensee will now submit a CRC Renewal form (HS 2125). The prior Attestation form is now obsolete and will be returned back to providers. The renewal form must be submitted as part of a renewal licensing application, and the renewal notice will still be sent out 130 days prior to expiration. The renewal application must be emailed to the DHS office that issues your license; the email address can be found in the chart below.
Entities licensed by OCDEL or ODP who use CLS or PELICAN to submit renewal applications must submit the renewal by email. The renewal is not part of the electronic CLS/PELICAN renewal application process. The CRC form for can be found on the DHS website under the “Application for License” page.
Previously, the DHS Bureau of Equal Opportunity (BEO) would issue you a letter verifying that you are compliant with applicable civil rights laws. With the new process, a letter from BEO will no longer be sent out to licensed entities. Instead, the issuance of the new license or renewal license will indicate that your CRC form or renewal form submission was approved. If there are issues or questions on the submitted CRC or renewal form, a staff member from BEO or DHS will contact you.
| If your license is issued by… |
Submit your application AND your CRC form (if new license)
or CRC Renewal (if license renewal) to: |
| The Bureau of Human Services Licensing (Renewals) – PCH & ALR |
[email protected] |
| For NEW applications for Personal Care Homes or Assisted Living Residences |
Send the application, supporting documents, Civil Rights Compliance Form (HS2126) and the application fee, check or money order payable to DHS to:
Via USPS: Or via courier:
DHS/BHSL DHS/BHSL
Room 623 Health & Human Services Bldg.
PO Box 2675 Rm 623
Harrisburg, PA 17105-2675 625 Forster Street
Harrisburg, PA 17120 |
| The Office of Children, Youth, and Families |
[email protected] |
| The Office of Mental Health and Substance Abuse Services |
[email protected] |
| The Office of Developmental Programs* |
[email protected] |
| The Office of Child Development and Early Learning* |
Child care providers should include their MPI number in the subject line and email the appropriate regional office:
Northeast Region:
[email protected]
Central Region:
[email protected]
Counties: Dauphin, Cumberland,
Lancaster, York, Adams, Lebanon and York
[email protected]
Counties: Snyder, Perry, Juniata, Centre, Mifflin, Tioga, Lycoming, Northumberland, Union and Clinton
South Region:
[email protected] |
|
Western Region:
[email protected]
Counties: Allegheny, Armstrong, Beaver, Butler, Cameron, Clarion, Clearfield, Crawford, Elk, Erie, Fayette, Forest, Greene, Indiana, Jefferson, Lawrence, McKean, Mercer, Potter, Venango, Warren, Washington and Westmoreland
[email protected]
Counties: Bedford, Blair, Cambria, Franklin, Fulton, Huntingdon and Somerset |
*Licensees who use CLS or PELICAN to submit renewal applications must submit the renewal by email. The renewal is not part of the electronic CLS/PELICAN renewal application process.
The new process is effective on Tuesday, October 1, 2024. Existing licensees and applicants must begin following the new process on or before that date.
If you have any questions about the new process, please contact the applicable DHS office, DHS Human Services Licensing Office at 717-705-0383, or, if your facility is a childcare facility, please reach the Office of Development and Early Learning (OCDEL) at Western Region 1-800-222-2149, Central Region (Harrisburg) at 1-800-222-2117, Northeast Region (Scranton) at 1-800-222-2108, or Southeast Region (North & South) at 1-800-346-2929.
If you have any questions or need assistance with the completion of your civil rights compliance application, please contact Bureau of Equal Opportunity Licensing office at 717-787-1579 or electronically.
Thank you for your commitment to protecting the rights of Pennsylvania’s most vulnerable citizens. If you have any additional questions, please contact your respective RCPA Policy Director.
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