Get the free TRANSFER FORM FOR 1915(I) SERVICES Date of Request - dhcfp nv

TRANSFER FORM FOR 1915(I) SERVICES Date of Request This form is to be completed when a recipient of 1915(i) services including Adult Day Health Care, Day Habilitation or Residential Habilitation is

How to fill out transfer form for 1915i

How to fill out transfer form for 1915i

1. Obtain the 1915i transfer form from the appropriate agency or online.
2. Fill in the applicant's personal information, including name, address, and contact details.
3. Provide details about the current service provider, including their name and contact information.
4. List the requested new service provider's information, ensuring all details are accurate.
5. Indicate the reason for the transfer clearly in the designated section.
6. Review the form for any errors or missing information.
7. Sign and date the form to certify the accuracy of the information.
8. Submit the completed form to the relevant agency as per their submission guidelines.

Who needs transfer form for 1915i?

1. Individuals currently enrolled in the 1915i program who wish to change their service provider.

For pdfFiller’s FAQs

How can I edit transfer form for 1915i from Google Drive?

You can quickly improve your document management and form preparation by integrating pdfFiller with Google Docs so that you can create, edit and sign documents directly from your Google Drive. The add-on enables you to transform your transfer form for 1915i into a dynamic fillable form that you can manage and eSign from any internet-connected device.

How can I send transfer form for 1915i for eSignature?

Once your transfer form for 1915i is ready, you can securely share it with recipients and collect eSignatures in a few clicks with pdfFiller. You can send a PDF by email, text message, fax, USPS mail, or notarize it online - right from your account. Create an account now and try it yourself.

How do I complete transfer form for 1915i on an Android device?

Use the pdfFiller Android app to finish your transfer form for 1915i and other documents on your Android phone. The app has all the features you need to manage your documents, like editing content, eSigning, annotating, sharing files, and more. At any time, as long as there is an internet connection.

What is transfer form for 1915i?

The transfer form for 1915i is a document used to report changes in the ownership or the controlling entity of a 1915i funded program.

Who is required to file transfer form for 1915i?

Providers and entities that are undergoing changes in ownership or control related to their 1915i waiver services are required to file the transfer form.

How to fill out transfer form for 1915i?

To fill out the form, provide the required identifying information about the current provider and the new owner or controlling entity, including their legal names, addresses, and any relevant identification numbers.

What is the purpose of transfer form for 1915i?

The purpose of the transfer form for 1915i is to notify regulatory authorities of changes in ownership or control in order to maintain compliance and ensure the continuity of care for clients.

What information must be reported on transfer form for 1915i?

The transfer form must report information such as the existing provider's details, new owner's details, the reason for the transfer, and any changes in services provided.