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Reports, Forms, Pamphlets and Policies

You can search for reports, forms, policies and pamphlet and posters with information about specific programs and services. 

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  1. Click on the tab that corresponds with the type of document type you are looking for, or click on the "All Documents" tab to search through all available documents. You can refine your search by selecting a category from the Filter by Category drop-down. 
  2. Type in a number or keyword in the "Search by Name, Number, or Keyword" box and click the Search button. When searching for a document by the exact title (form name), place the title within quotation marks. 
  3. You can click on the column headers to sort the search results.


Number Document Name Effective Date
LCR-1084A Application for Renewal or Amended HCBS Certificate for Independent Providers (English) 02/01/2023
FAA-0001U Notice of Non-Discrimination/Aviso De No Discriminación AH-1000 02/01/2023
DDD-2173A Request for Amended/Correction of Protected Health Information (PHI) 02/01/2023
LCR-1084A-S Application for Renewal or Amended HCBS Certificate for Independent Providers (Spanish) 02/01/2023
DDD-2171A Accounting Disclosures Tracking 02/01/2023
DDD-2174A Request for Restriction of Protected Health Information (PHI) 02/01/2023
DDD-1883A-S ¿Qué es PASRR? Una guía para las familias 02/01/2023
DDD-2172A Authorization of Disclosure of Confidential Substance Use Disorder (SUD) Record Information 02/01/2023
DDD-1580A Reversal Adjustment Request Cover Sheet (English) 02/01/2023
CCA-1216A Notice to All Families Enrolled at DES Child Care Facility/Aviso A Todas Las Familias Inscritas En Una Instalación De Cuidado De Niños Del DES 02/01/2023

Number Document Name Effective Date
CSE-1171A Affidavit of Financial Information (English/Spanish) 04/01/2018
LCR-1080B Licensing Investigation Procedural Tool 04/01/2018
ETA- 081A -S Suplemento a la Solicitud para Solicitantes de DUA que Trabajan por Cuenta Propia 04/01/2018
DDD-281 Adult Developmental Home Agreement (English) 04/01/2018
ETA-081A Supplement to Application for DUA Self-Employed Individuals 04/01/2018
DDD-289 Child Developmental Foster Home Agreement 04/01/2018
PAU-592 Data Disclosure Information and Fee Schedule 04/01/2018
DDD-1401A Center Based Employment - Quarterly Report (English) 04/01/2018
UIT-1146A Limited Power of Attorney (English) 04/01/2018
UB-108 Name and Address Change Request (English / Spanish) 03/01/2018

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