(a) An applicant for a license shall submit an application to the Secretary.
(b) The application:
(1) Shall be on the form that the Secretary requires;
(2) Shall be signed and verified by the individual; and
(3) Shall include:
(i) The name of the applicant;
(ii) A statement that the applicant meets the requirements of this subtitle;
(iii) The location of the proposed hospice;
(iv) The name of the individual who is to be the medical director of the hospice care program; and
(v) Any other information that the Secretary requires.
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