Template / Form

This tool was developed to help participants in Cash & Counseling programs set personal goals. There are three major objectives sighted for the process: To develop a structured process to ensure that the participants’ goals are clearly articulated and that the spending plan represents the needs and wishes of the consumer, to assure and improve quality at the individual level, and to use data collected for quality improvement at the program level.

A two page open ended questionnaire to help consumers determine what services and purchases will help meet their needs.

This website contains forms, brochures and enrollment information for Florida's Consumer Directed Care program.

States have developed sample timesheets for participants to use with their employees. Several examples are available here.

Job descriptions for support brokers in New Mexico, Vermont, Washington and West Virginia are all available.

This form was developed for the Flexible Choices program to request payments for services, goods and cash.

This spreadsheet was developed for Vermont's Flexible Choices program and it allows you to put in the basic client demographics as well as the key elements to their budget development and then automatically creates the other forms you need to complete a budget. Included are: the Intake Sheet, the Budget Sheet, the Allowance Form, and a Rate Calculator.

This toolkit was developed to help Cash & Counseling grantees develop their communications materials. The toolkit includes templates for a press release, a FAQ sheet, an Op-Ed letter, and a letter to eligible consumers.

Forms are provided for designating a representative and screening a representative for Arkansas' IndependentChoices program.

A template used by Arkansas' IndependentChoices program and a sample report cover page.