Bureau of Facilities and Licensing Payments

License Type * License Type is Required
Select License Type Home Health Agency (Skilled Services) Home Health Agency (Non-Medical) Birthing Center
Reason for Payment * Reason for Payment is Required
Select Reason For Payment Initial License License Renewal
Which Agency are you Submitting Payment For? * Agency Name Required

Administrator First Name:* * First Name Required * Invalid Format	Administrator Last Name:* * Last Name Required * Invalid Format
Administrator Email * Administrator Email Required Email Invalid Format

Total Payment Amount

NOTE:*** Steps to complete Registration and Payment via credit card or check.
1. Submit the registration form after confirmation
2. You will be redirected to a payment page managed by PayIT
3. Enter Payment method as either credit card or bank account or check
4. Click Pay buttton once payment method is verified (maximum number of tries is 3)
5. Payment and registration confirmation will be sent via email to the selected contact for payment

Billing First Name:* Billing First Name Required Billing First Name Invalid Format	Billing Last Name:* Billing Last Name Required Billing Last Name Invalid Format
Billing Phone:* Billing Phone Required	Billing E-Mail Address:* Billing Email Required Billing Email Invalid Format

Notes/Comments:

**Once you click the -Submit Payment Form- button, your license payment for the KDHE Bureau of Facilities and Licensing will be redirected to the PayIT. You will need to finish the process, and once processed, you will receive a Payment confirmation and email notification to be billed with all the details.**