How to apply for information provision

Please submit the "FAX Information Provision (Temporary) Application Form" in advance at the fax or window.
After receiving the fax and bringing the counter, 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 (provisional) Application Form (PDF: 107KB)” (Hodogaya Ward style)
FAX number: 045-331-6550 (addressed to The Long-term Care Insurance, Hodogaya Ward Office)

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

Please send the following required documents to Hodogaya Ward Office The Long-term Care Insurance.

〒240-0001
Address The Long-term Care Insurance on the first floor of the main building of the Hodogaya Ward Office, 2-9 Kawabe-cho, Hodogaya-ku, Yokohama

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

1 Information provision application form pertaining to certification for long-term care (double-sided printing)
・“Information Provision Application Form” (Please dow Road from Health and Social Welfare Bureau HP 6. Nursing Care Certification Information Provision)

2 Documents that clarify the contract with the Target Company
<In the case of home care support establishments>
・Request for Home Care Prevention Service Plan Creation registration form ※And the “Insured person ID” of the target person (if submitted, any can be omitted)
※When home care support establishment entrusted by care plaza applies about person in need of support, "copy of contract between three parties" or "use contract" is necessary.
※"Home / Nursing Care Prevention Service Plan Creation Request registration form" (Please download from Health and Social Welfare Bureau HP 1 Certification Related to Long-Term Care)

<In the case of entrance facilities>
・Copy of "Usage Confirmation Certificate"
Please attach a copy of the entrance agreement and the signatures of both Name of the facility and the seal confirmation.
<In the case of insured persons transferred to other municipalities>
・A copy of the insured person's card at the new municipal office
※If the name of the office is stated on the insured person's card, only the insured person's card is acceptable.
・Copy of home notification certificate
・A copy of the contract (with the insured)

3 Certificate that the applicant belongs to a home care support company, etc.
　"Employee ID Card/Employee ID Card" with the company name and company seal, or certificate of employment instead ※(Business cards are not allowed)
　　For staff IDs and employee IDs, please present the original when visiting the counter, and attach a copy when mailing. In the case of submission by certificate of employment, please submit the original.
　※“certificate of employment” (Health and Social Welfare Bureau HP 6. Please dow Road for providing nursing care certification information.)

4 Reply envelope with a stamp (* mail only)
Please fill in the return address on the reply envelope and attach a stamp for the amount (postage + simple registered mail fee (350 yen)). Return will be done by registered mail. (The rates after the postage revision on October 1, 2024 are posted.)

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