Financial Worksheet
Below is a link to a Microsoft Word document of the consumer Financial Worksheet that should be used for determining program eligability. Download Financial Worksheet 4-2014
Applicant Consent and Disclosure Form
The link below is for a Microsoft Word document to be used by ASAPs to aquire the appropriate level of consumer information consent and disclosure. Download EOEA Applicant Consent and Disclosure Form (2)
Notification of Non-Participation
The link below is a Microsoft Word document that contains the appropriate text for a notice of non-participation in the Home and Community-Based Services Waiver Program. Download Notification of Non-Participation revised 12-10-13
Recipient Choice Letter
The link below is a Microsoft Word document that contains the appropriate language to be included in a Recipient Choice Letter. Download Recipient Choice Form
Medicaid Intent to Refer Letter
The link below is a Microsoft Word document with the text to be included in a letter of referral to Medicaid. Download Intent to Refer Revised 12 11 2013