New Architectural Waiver Form for ACF and Assisted Living Providers

The Department of Health (DOH) has developed a new architectural waiver form to be used when seeking a waiver of adult care facility (ACF) or assisted living architectural requirements. Click here to view the Dear Administrator letter (DAL), which provides information about the process, and here to view the waiver form.

This new form should be submitted along with the Adult Care Facility (ACF) Waiver Request/Equivalency Notification Form (DOH-4235). The architectural waiver must be filled out in its entirety and completed and signed by a licensed architect. This information, along with any supporting documentation, should be submitted to your Regional Office, with copies sent to:

New York State Department of Health, Attention: Linda O'Connell, 875 Central Avenue, Albany, NY 12206

Questions regarding the forms should be directed to your DOH Regional Office.

Contact: Diane Darbyshire, ddarbyshire@leadingageny.org, 518-867-8828