Forms

Family Support/ Participant Directed Managed Services/Adult Service Coordination

BDS: Why Should Individuals with Developmental Disabilities Apply for Medicaid? (PDF)

Intake Application for Services (PDF)

Ingesta Solicitud de Servicios Espanol  (PDF)

Medicaid Information and Link (PDF)

2022 Payroll Calendar (PDF)

2022 HOLIDAY SCHEDULE STAFF (PDF)

2022 HOLIDAY SCHEDULE FIELD EMPLOYEES (PDF)

2022 SINGLE CARE CDS Timesheet (PDF)

2022 SINGLE SENIORS Timesheet (PDF)

2022 SINGLE VETERANS Timesheet (PDF)

Completing The Timesheet Instructions

Direct Deposit Authorization Agreement (PDF)

Mileage & Expense Reimbursement Form (PDF)

Consent To Bill (PDF)
Consent To Bill, Spanish (PDF)
COVID 19 Relief Fund Guidelines (PDF)
COVID 19 Relief Fund Guidelines Spanish (PDF)
COVID 19 Relief Fund Application (PDF)
COVID 19 Relief Fund Application Spanish (PDF)
Discretionary Funds Printable Application (PDF)
Discretionary Funds Printable Application, Spanish (PDF)
Environmental Modifications Pre-Survey Form (PDF)
Family Support Information (PDF)
Family Support Information, Spanish (PDF)
Respite Reimbursement Form (PDF)
Respitality Request(PDF)
Respitality Request, Spanish (PDF)

Guardianship Guide (PDF)
High School Transition Planning Checklist (PDF)
Medicaid Guide (PDF)
Medicaid Reference Sheet (PDF)
Social Security Guide (PDF)
Project Services Needs/Wait List Guide (PDF)

HIPAA Notice Of Privacy Practices (PDF)

HIPPA Notice Of Privacy Practice_Spanish (PDF)

NCI SURVEY LIVES AT HOME WITH FAMILY MEMBER

NCI SURVEY DOES NOT LIVE AT HOME WITH A FAMILY MEMBER

Universal Precautions Training (PDF)