CN-3 (Instructions)
NOV 16 Page 1 of 6 Pages.
New Jersey Department of Health
CERTIFICATE OF NEED APPLICATIONS
FOR HOSPITAL-RELATED PROJECTS
_________________________________________________________________________________________________________
SECTION I. GENERAL REQUIREMENTS
1. CERTIFICATE OF NEED
A. PRE-SUBMISSION
Prior to the preparation of the application materials, it is strongly recommended that the applicant discuss the proposed
project with the local advisory board in the service area presently served or anticipated and staff of the New Jersey
Department of Health.
B. SUBMISSION - NEW JERSEY DEPARTMENT OF HEALTH
Submit one completed application in electronic media and 35 paper copies of the application forms and all required
documentation to:
Mailing Address:
New Jersey Department of Health
Office of Certificate of Need and Healthcare Facility Licensure
P. O. Box 358
Trenton, NJ 08625-0358
Overnight Services (DHL, FedEx, UPS):
New Jersey Department of Health
Office of Certificate of Need and Healthcare Facility Licensure
25 South Stockton Street, 2nd Floor
Trenton, NJ 08608-1832
C. SIGNATURE
All applications must be signed by the current Chief Administrative Officer or Board Chairman of the Hospital.
D. FILING FEE
All applications must be accompanied by a certified check, cashier's check, or money order made payable to "Treasurer,
State of New Jersey." Failure to submit the appropriate fee at the time of filing may result in rejection of the application.
FEE SCHEDULE:
Total Project Cost (TPC) Fee Required
$1,000,000 or Less $7,500
Greater Than $1,000,000 $7,500 + 0.25% of TPC
Transfer of Ownership $7,500
Change in Scope or Location $7,500 + 0.25% of cost in excess of approved TPC, where excess is
$1,000,000 or more
C. Change in Cost No Certificate of Need required; 0.25% of cost in excess of approved TPC,
where excess is $1,000,000 or more, shall be remitted prior to licensure
E. COMPLETENESS
1. ALL QUESTIONS REQUIRE AN ANSWER AND ALL SCHEDULES MUST BE COMPLETELY FILLED OUT.
2. Certificate of Need forms must be filed in sequential order. Do not renumber pages.
3. All exhibits must be identified as noted herein and attached to the back of the Certificate of Need Application form
and referenced to the corresponding item in the appropriate section.
4. Identify each response in the narrative section by question number and respond in sequential order. All additional
