You can search for reports, forms, policies and pamphlet and posters with information about specific programs and services.
Download | Number | Name | Effective Date |
---|---|---|---|
|
DDD-1580A | Reversal Adjustment Request Cover Sheet (English) | 02/01/2023 |
|
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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LCR-1084A-S | Solicitud de Renovación o Certificado de HCBS Modificado para Proveedores Independientes | 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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RSA-1322A | Pre-Employment Transition Services | 02/01/2023 |
Download | Number | Name | Effective Date |
---|---|---|---|
|
CCA-0218A | Sign-In/Sign-Out Record (English) | 10/01/2019 |
|
CCA-0218B | Sign-In/Sign-Out Record (Extended Version) | 10/01/2019 |
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CCA-0218B-S | Registro de Entradas y Salidas (Versión extendida) | 10/01/2019 |
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CCA-0218A-S | Sign-In/Sign-Out Record (Spanish) | 10/01/2019 |
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LCR-1034A | Criminal History Self Disclosure Affidavit (English) | 10/01/2019 |
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LCR-1034A-S | Criminal History Self Disclosure Affidavit (Spanish) | 10/01/2019 |
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AAA-1120A | Participant Evaluation | 09/01/2019 |
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CSE-1007 | Customer Satisfaction Survey | 09/01/2019 |
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DDD-1532A | Hardship Reduction Request (English) | 09/01/2019 |
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DDD-1532A-S | Hardship Reduction Request (Spanish) | 09/01/2019 |
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Pursuant to Title VI of the Civil Rights Act of 1964, the Americans with Disabilities Act (ADA) and other nondiscrimination laws and authorities, ADES does not discriminate on the basis of race, color, national origin, sex, age, or disability. Persons that require a reasonable modification based on language or disability should submit a request as early as possible to ensure the State has an opportunity to address the modification. The process for requesting a reasonable modification can be found at Equal Opportunity and Reasonable Modification