You can search for reports, forms, policies and pamphlet and posters with information about specific programs and services.
Download | Number | Name | Effective Date |
---|---|---|---|
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LCR-1084A | Application for Renewal or Amended HCBS Certificate for Independent Providers | 02/01/2023 |
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DDD-1658A | Agency With Choice: Individual Representative (English) | 02/01/2023 |
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DDD-1658A-S | Agency With Choice: Individual Representative (Spanish) | 02/01/2023 |
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DDD-2173A | Request for Amended/Correction of Protected Health Information (PHI) | 02/01/2023 |
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FAA-0001U | Notice of Non-Discrimination/Aviso De No Discriminación AH-1000 | 02/01/2023 |
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DDD-2171A | Accounting Disclosures Tracking | 02/01/2023 |
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DDD-2174A | Request for Restriction of Protected Health Information (PHI) | 02/01/2023 |
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CSE-1225A | Caretakers Raising Children | 02/01/2023 |
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RSA-1322A | Pre-Employment Transition Services | 02/01/2023 |
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CSE-1225A-S | Cuidadores que Crían Niños | 02/01/2023 |
Download | Number | Name | Effective Date |
---|---|---|---|
|
UIA-1060A | Filing of Weekly Claims (English/Spanish) | 08/01/2019 |
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UIB-0098A | Eligibility Investigation Record | 08/01/2019 |
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DDD-1328B | Referral to Vocational Rehabilitation Packet (English) | 08/01/2019 |
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AAA-1122A | Host Agency Application | 08/01/2019 |
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DDD-0524A-S | Authorization for Release of Information (Spanish) | 08/01/2019 |
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RSA-1376A | Request for Vending Services Placement | 08/01/2019 |
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CCA-1261A | Certified Family Child Care Provider Application | 07/01/2019 |
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RSA-1312A | Authorization for Disclosure of Health Information to RSA | 07/01/2019 |
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RSA-1312A-S | Autorización Para Divulgación De Información De Salud a RSA | 07/01/2019 |
|
UB-099-Y | Certification of Understanding (English / Spanish) | 07/01/2019 |
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