Application for Reduction in Long-Term Care Home Basic Accommodation – Consent to Collection, Use and Disclosure of Information for Automated Income Verification with the Canada Revenue Agency

Pursuant to section 187 of the Fixing Long-Term Care Act, 2021, the Director may directly or indirectly collect the information provided in this application to determine the reduced amount payable by the resident for basic accommodation in accordance with section 303 of O. Reg. 246/22 made under the Fixing Long-Term Care Act, 2021. Pursuant to subsection 303(4) of O. Reg. 246/22, the licensee is required to submit this application and retain a copy.

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Form Number 5082-69
Title Application for Reduction in Long-Term Care Home Basic Accommodation – Consent to Collection, Use and Disclosure of Information for Automated Income Verification with the Canada Revenue Agency
Description Pursuant to section 187 of the Fixing Long-Term Care Act, 2021, the Director may directly or indirectly collect the information provided in this application to determine the reduced amount payable by the resident for basic accommodation in accordance with section 303 of O. Reg. 246/22 made under the Fixing Long-Term Care Act, 2021. Pursuant to subsection 303(4) of O. Reg. 246/22, the licensee is required to submit this application and retain a copy.