Dfps Form J-800-2839 - Request For Exemption From Regulation Page 4

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J-800-2839
Revised June 2014
SECTION G: FOREIGN EXCHANGE OR FOREIGN SPONSORSHIP PROGRAM
Complete this section if you are requesting an exemption based on meeting the requirements for a foreign Exchange
or foreign sponsorship program under 40 TAC §745.117(4).
Does your program offer a living arrangement in a caretaker's home where all of the following are true:
An unrelated child or sibling group lives in the caretaker's home
•
Each child lives in the United States on a time-limited visa
•
•
Each child is being sponsored by person with whom they are living or by an organization?
No
Yes
If yes, describe the living arrangement?
SECTION H - HOW DFPS PROCESSES YOUR REQUEST
If the information you submit does not fully demonstrate that your program is exempt, we may request additional
documentation or visit your program to obtain additional information.
If we determine that your program does not meet all of the criteria for an exemption, we will send you a letter stating
that you must apply for a permit. The letter will also explain how to request an administrative review if you do not
agree with Licensing's decision.
If Licensing determines that your program is subject to regulation, you will be operating illegally if you continue to
operate without meeting Licensing requirements. We may file suit in district court for both a civil penalty and
injunctive relief, if you knowingly engage in activities that require a license or registration.
SECTION I - PRIVACY STATEMENT
DFPS values your privacy. For more information, read our privacy policy online at
SECTION J - CERTIFICATION
I certify that the above description of the program is accurate, true, and complete. I understand that I may be
required to provide additional information to show the program meets all requirements to be exempt from Licensing
regulation.
Signature of Owner, Partner, or
Title
Date Submitted to Licensing:
Head of Governing Body:
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