(a) Applicants for provision of IDCMP services shall submit a completed application, “Impaired Driver Care Management Program (IDCMP) Application” (December 2023), along with required supporting documentation outlined in (b) below and non-refundable $150.00 application fee to the department via email, or mailed to:
Department of Health and Human Services
Bureau of Drug and Alcohol Services
c/o Impaired Driver Services Coordinator
105 Pleasant Street
Concord, NH 03301
(b) The following documentation shall be submitted with the application in (a) above:
- (1) Program staff list, including resumes and copies of any staff professional licenses;
- (2) Certification of insurance for general liability and workers’ compensation;
- (3) A Certificate of good standing from the New Hampshire Secretary of State;
- (4) Certificate of occupancy for each service site;
- (5) Policy and procedure manual;
- (6) Curriculum syllabus for impaired driver education program (IDEP);
- (7) A year-to-date profit and loss statement (P&L) for the prior full 4 years for the agency associated with the IDCMP;
- (8) Consolidated cash flow for the prior 4 full years for the agency associated with the IDCMP; and
- (9) Balance sheet years for the agency associated with the IDCMP.
- (c) If the IDCMP is part of a setup organization, the information in (b)(7)-(9) above shall not be required.
Source. #10240, eff 1-1-13; ss by #13846, eff 1-6-24, EXPIRES: 1-6-34