How to apply for information provision

Please submit the "FAX Information Provision (Temporary) Application Form" in advance at the fax or at the counter.
After receiving the fax and bringing the window, it takes about one week to provide it. Please bring the following required documents to the ward office when you receive it.

“FAX Information Provision (Temporary) Application Form (PDF: 107KB)” (Hodogaya Ward style)
FAX number: 045-331-6550 (address to The Long-term Care Insurance, Hodogaya Ward Office)
※Please send it to the above fax number, not the fax number described in the application form.

1. Information provision application pertaining to certification for long-term care
2. Documents that reveal the contract with the principal
3. Certificate that the applicant belongs to a home care support company.

Please send the following required documents to the person in charge of The Long-term Care Insurance, Hodogaya Ward Office.

〒240-0001
The Long-term Care Insurance, 1F, Hodogaya Ward Office Main Building, 2-9 Kawabecho, Hodogaya-ku, Yokohama

1. Information provision application pertaining to certification for long-term care
2. Documents that reveal the contract with the principal
3. Certificate that the applicant belongs to a home care support company.
4. Reply envelope (with stamp attached)

1 Information Provision application form (double-sided printing) pertaining to certification for long-term care
・"Information Provision Application Form" (Health and Social Welfare Bureau HP 6. Please load Dow from related to nursing care certification information provision)

2 Documents in which the contract with the target person
<In the case of home care support offices>
・registration form, “Request for Home Care Prevention Service Plan” ※And "Insured person's card" (if submitted, all cases can be omitted)
※When home care support establishment entrusted by care plaza applies for person in need of support, "copy of contract between three parties" or "use contract" is necessary.
※"Home / Care Prevention Service Plan Creation Request registration form" (Please download from Health and Social Welfare Bureau HP 1 certification for long-term care.)

<In the case of the entrance facility>
・Copy of "Usage Confirmation Certificate"
Please attach a copy of the place whereName of the facility andseal can be confirmed.
<In the case of insured persons who have been transferred to other municipalities>
・A copy of the insured person's card at the new municipal office
※If the name of the establishment is stated on the insured person's card, only the insured person's card is acceptable.
・Copy of home notification card
・A copy of the contract (with the insured)

3 Certificate that the applicant belongs to a home care support company.
　"Employee ID/Employee ID" with the company name and company seal, or certificate of employment ※(Business cards are not allowed.)
　　About staff card, employee ID card, please show original at window next agency, and attach copy at the time of mail. In the case of submission of certificate of employment, please submit the original.
　※"certificate of employment" (Health and Social Welfare Bureau HP 6. Please load the nursing care certification information provision related Dow Road)

4 Envelope for reply with stamp(* mail only)
Fill in the return address on the reply envelope, and attach a stamp for the amount (postal fee + simple registered mail fee (350 yen)). Returns will be made by registered mail. (Posts after the revision of postage rates on October 1, 2023)

For the latest postage rates, please check the post office website.
Japan Post Co., Ltd. website (outside site) (external site)