(1) a completed application, including required attestations, on forms furnished by the office or approved equivalents. Such application and attestations must include an agreement by the applicant to operate the group family day care home in conformity with applicable laws and regulations;

(2) medical statements for the provider, assistant(s), and substitute(s) completed within the 12 months preceding the date of application, as required in section 416.11 of this Part;

(3) a summary of the training and experience of the provider and assistant(s) as described in section 416.13 of this Part;

(4) the names, addresses and day time telephone numbers of at least two acceptable references each for the provider, assistant(s), and any substitute(s) as specified in section 416.13 of this Part;

(5) sworn statements by the provider, assistant(s), substitutes and any person 18 years of age or older who resides in the proposed group family day care home indicating whether, to the best of their knowledge, they have ever been convicted of a misdemeanor or a felony in New York State or any other jurisdiction, and fingerprint images as required pursuant to section 413.4 of this Title;

(6) certification, on forms provided by the office, of the status of the individual applicant's child support obligations or payments, in accordance with the requirements of section 3-503 of the General Obligations Law;

(7) certification, on forms provided by the office, that the applicant is in compliance with workers compensation requirements of New York State Law;

(8) Statewide Central Register of Child Abuse and Maltreatment and Justice Center for the Protection of Persons with Special Needs.

(9) a medical statement on forms furnished by the office or approved equivalents regarding the health of all persons residing in the group family day care home completed within the 12 months preceding the date of application, as required in section 416.11 of this Part;

(10) a statement from the appropriate local official or authority that the dwelling meets standards for sanitation and safety, where the office notifies the applicant that such a statement is required;

(11) where a licensee uses a private water supply:

(12) a report of inspection performed within the 12 months preceding the date of application, by local authorities or an inspector qualified to approve fuel burning systems, which documents approval of any wood or coal burning stove, fireplace, pellet stoves or permanently installed gas space heater in use at the home;

(13) certification, on forms provided by the office, that the dwelling, its property and premises, and the surrounding neighborhood and environment are free from environmental hazards. Where the historical or current use of the dwelling, its property and premises, or the surrounding neighborhood indicate that an environmental hazard may be present, inspection or testing must be completed by the appropriate local official or authority to determine if such hazard exists. Documentation of the inspection or testing must be appended to the statement required by this paragraph and include a statement from the appropriate local official or authority following this inspection and/or testing that the dwelling, its property and premises, and the surrounding neighborhood, meet applicable standards for sanitation and safety. Such hazards include but are not limited to, dry cleaners, gas stations, nuclear laboratories or power plants, property designated as a Federal superfund clean-up site, and any property with known contaminated ground or water supplies;

(14) the site to be used for child care must meet the definition and requirements of a personal residence as outlined in Part 413 of this Title. The licensee must submit documentation, acceptable to the office, to prove that the group family day care site is being used as a residence;

(15) a health care plan developed in accordance with requirements of section 416.11(c) of this Part; and

(16) an email address for the provider or other person designated to receive communications from the office. If the applicant is unable to provide at least one valid email address, the applicant must provide a valid mailing address for the provider or other person designated to receive written communications from the office.

(1) a completed application for renewal, including required attestations, on forms furnished by the office or approved equivalents. Such application and attestations must include an agreement by the applicant to operate the group family day care home in conformity with applicable laws and regulations;

(2) certification, on forms provided by the office, of the status of the individual applicant's child support obligations or payments, in accordance with the requirements of section 3-503 of the General Obligations Law;

(3) certification, on forms provided by the office, that the applicant is in compliance with workers compensation requirements of New York State Law;

(4) certification, on forms provided by the office, that the dwelling, its property and premises, and the surrounding neighborhood and environment are free from environmental hazards. Where the historical or current use of the dwelling, its property and premises, or the surrounding neighborhood indicate that an environmental hazard may be present, inspection or testing must be completed by the appropriate local official or authority to determine if such hazard exists. Documentation of the inspection or testing must be appended to the statement required by this paragraph and include a statement from the appropriate local official or authority following this inspection and/or testing that the dwelling, its property and premises, and the surrounding neighborhood, meet applicable standards for sanitation and safety. Such hazards include but are not limited to, dry cleaners, gas stations, nuclear laboratories or power plants, property designated as a Federal superfund clean-up site, and any property with known contaminated ground or water supplies;

(5) where a licensee uses a private water supply:

(6) a report of inspection and approval performed by local authorities or an inspector qualified to approve fuel burning systems, within the 12 months preceding the date of application for renewal of any wood or coal burning stove, fireplace, pellet stoves, or permanently installed gas space heater in use at the home;

(7) proof of compliance with the training requirements of section 416.14 of this Part;

(8) a statement from the appropriate local official or authority that the dwelling meets satisfactory standards for sanitation and safety, where the office notifies the applicant that such a statement is required; and

(9) an email address for the provider or other person designated to receive communications from the office. If the applicant is unable to provide at least one valid email address, the applicant must provide a valid mailing address for the provider or other person designated to receive written communications from the office.