Book Appointment Now
Payment Request Form & Narrative (Attachment 3)
Used to submit waiver-related payment requests.
admin
HQS Checklist (Attachment 4)
Housing Quality Standards checklist for inspections.
Sample Lease (Attachment 5)
Example lease agreement for waiver housing assistance.
Household Goods Actual Expenditures (Attachment 6)
Document for tracking actual household goods expenditures.
Waiver Participant Attestation (Attachment 7)
Signed attestation confirming participant agreement.
Budget Form (Attachment 8)
Official budget form for waiver services.
Waiver Participant Contract (Attachment 9)
Contract agreement outlining participant obligations.
Waiver Services Contact List (C-1.5)
Contact list of waiver service providers and resources.
Change in Provider Request
Form used to request a change in service provider.
Change in Service Coordinator Form
Form to request a change of assigned service coordinator.