Part I. Processing the Application
An application and all schedules can be downloaded from link on right side of this page under "Related Link" DASA Licensing and Certification Forms.
The Application Packet includes
- A copy of Administrative Code 2060, the licensing regulations.
- An initial licensing application.
- An Architect's Life Safety Inspection Report.
A Compliant Application includes
- Development and submission of a set of operating policies and procedures based on Administrative Code 2060 for the operation of your agency, including policies and procedures specific to the services that you are applying to provide.
- Completion of the initial license application and appropriate schedules included in the application.
- Completion of the Architect's Life Safety Inspection Report by an architect licensed by the Illinois Department of Financial and Professional Regulation.
- The submission of a $200 application fee in the form of a check or money order made payable to the Department of Human Services.
Operating policies and procedures must be developed using Administrative Code 2060.
Note: The development of the agency's policies and procedures should be viewed as a learning experience by the applicant. The purchase of policies and procedures from consultants should be avoided.
The application form is a ten page document which also includes schedules A, C, E, L and a federal form W-9 and associated instructions.
Page 1 of the Application
- Organization Information :
- The information provided here concerns the home address of the applicant's agency. It can be the home address of the applicant, the address of the office at which the services shall be provided, or any address that the applicant specifies. Note: Communication from DASA to the agency will always be directed to this address.
- Please Specify:
- If the applicant's agency is part of a governmental body, check one of the categories in Government entity.
- If the agency is incorporated, check if it is for profit or not for profit.
- Check if the agency is a partnership, association, sole proprietor other type of entity.
- Include the agency's FEIN. (This is the Federal Tax Number) Tip. A sole proprietor may use his/her Social Security Number.
- This section contains information about where the licensed services will be provided. The information may be the same as under Organization Information and must be completed.
Page 2 of the Application
- Authorized Organization Representative.
- If the agency is incorporated, provide a list of board members and the name, address and telephone number of the Chairman of the Board. (Not Required of sole proprietors. )
- Levels of Care
- Indicate the levels of care that you want to be licensed.
Page 3 of the Application
- Intervention Programs
- Indicate the intervention service you want to be licensed.
- Facility Requirements
- Professional Staff Requirements
- Refer to Administrative Code 2060 for the credentials required of those who will be providing direct clinical and intervention services. Note. Lack of credentials does not preclude one from obtaining a license. However, a credentialed person must be hired to provide direct services.
Page 4 of the Application
- Medical Director
- A medical director is required for all treatment programs. Refer to Rule 2060.413 for the credentials required of a medical director and the medical director's responsibilities.
- Operations Manual and Substance Abuse Treatment
- Same as Page 1, # 1 under a compliant application
Page 5 of the Application
- Intervention Licenses
- If you intend to provide DUI evaluation and/or DUI Risk Education services in a language other than English, you must identify those languages on the space provided.
- If you are applying for a Recovery Home license the requirements are listed on pages 5 and 6 of the application and in rule 2060.509. Information about required staff credentials and physical plant requirements are provided.
Note: Recovery homes are not required to be handicapped accessible but must meet National Fire Protection Association standards based on the number of residents.
Pages 6 & 7 of the Application
- Medicaid Certification
Page 8 of the Application
- Estimated Client Population Grid
- This grid is to be filled out when applying for Medicaid certification only. It's purpose is to help the Department of Human Services to project costs.
Page 9 of the Application
- Applicant Affirmation
- The applicant must read and sign this document and return it with the application. If the applicant is a corporation or a partnership, the Applicant Affirmation must be signed by the authorized representative and a board member if a corporation or in the case of a partnership by both partners. Applications from sole proprietors need only one signature.
- All Applicant Affirmations must be notarized
- The application packet contains four documents known as Schedules A, C, E and L.
- Schedule A/ Ownership Disclosure must be completed by all applicants. If the agency is a corporation, Schedule A must be completed by all stockholders holding 5% or more of the corporate stock.
- Schedule C is the form on which the licensed architect who does the life safety inspection of the applicant's facility attests that the facility is in compliance with the National Fire Protection Association standards as well as the State and Federal handicapped accessability laws.
- Schedule E is the form required to be completed by the Medical Director of the agency seeking a treatment license.
- Schedule L is the form required to be completed by all professional staff providing direct client services.
- Questions regarding the completion of the application can be directed to DHS-Division of Alcoholism and Substance Abuse licensing staff at 312-814-3840.
Part II. Applying for Funding
After having completed the licensing and accreditation process of the Illinois Department of Human Services' Division of Alcoholism & Substance Abuse (IDHS/DASA) and being approved to hold a IDHS/DASA license, an organization can operate as a non-funded entity. In the event that the licensed organization desires to obtain IDHS/DASA funding to serve eligible indigent individuals and/or their families, they may submit a request for funding to IDHS/DASA. An application for funding can be submitted by responding to a Request for Proposal issued by the Department of Human Services or by sending a letter of inquiry regarding the availability of future funding opportunities. This inquiry may be sent to the following address:
Illinois Department of Human Services
Division of Alcoholism and Substance Abuse
401 South Clinton Street, 2nd floor
Chicago, IL 60607
The letter should highlight the following:
- Rationale for and amount of funding requested.
- Population and geographic area to be served.
- Number of persons projected to receive services.
- Verification of unmet need.
- Brief history of the organization/ individual vitae.
- Three letters of community support.
- Provider's ability to deliver services using evidence based models.
- Provider's history in providing addiction treatment and other related services.
Responses should be brief and the letter should not exceed more than five pages, single-spaced on standard 8.5 x 11 paper. Each letter of inquiry will be reviewed on its own merit and a response will be issued regardless of whether or not funding is available or awarded.