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)

2021 Payroll Calendar (PDF)

2021 HOLIDAY SCHEDULE STAFF (PDF)

2021 HOLIDAY SCHEDULE FIELD EMPLOYEES (PDF)

2021 SINGLE CARE CDS Timesheet (PDF)

2021 SINGLE SENIORS Timesheet (PDF)

2021 SINGLE VETERNS Timesheet (PDF)

Completing The Timesheet Instructions

Direct Deposit Authorization Agreement (PDF)

Mileage & Expense Reimbursement Form (PDF)

Campership Request Instructions FY21 English (PDF)
Campership Request Instructions FY21 Spanish (PDF)
Campership Request Application FY21 English (PDF)
Campership Request Application FY21 Spanish (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)