Rate Increase Notice Letter
Professional Rate Increase Notice Letter template for Adult Family Homes. Includes editable Word (.docx) and printable PDF formats.
[YOUR ADULT FAMILY HOME NAME HERE]
Rate Increase Notice Letter
TEMPLATE • Inspection-Ready AFH Standard
1. Notice Date & Statutory 30/60-Day Timeline
This agreement is entered into on this _____ day of ____________, 20___, between [ADULT FAMILY HOME NAME] (Provider) and [RESIDENT / POA NAME].
2. New Fee Breakdown & Reason Statement
FINANCIAL TERMSBase Rate & Payment Schedule: Resident agrees to pay Provider a monthly base fee of $______ payable in advance on the first (1st) day of each calendar month.
3. Section 3: Discharge Protocols & Signatures
Provider Signature / Date
Resident / POA Signature / Date
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Document Section Breakdown (2 Sections)
Notice Date & Statutory 30/60-Day Timeline
Formal written notice header in accordance with standard AFH notice timelines.
New Fee Breakdown & Reason Statement
Itemized summary of upcoming rate adjustment and care assessment changes.
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