Agency approval/certification information

Certification Status

Select the status of the agency's certification application. This field defaults to "Pending." This field is required.

Application Type

Select the type of certification the agency is applying for. This field is required.

Amendment Reason

If you selected Amendment in the Amendment Type field, select the reason for amending the certification record.

Certification Effective Date

Enter the date  the certification is in effect. Use the format MM/DD/YYYY.

Certification Expiration Date

Enter the date the certification expires. Use the format MM/DD/YYY. This date may not be more than two years after the effective date.

Temporary Expiration Date

Enter the date a temporary certification expires. Use the format MM/DD/YYYY. This field is enabled when  you select a license type of "Temporary" for at least one function. This date may not be more than 2 years after the effective date.

Comments

Enter any additional information about this certification or application.