Template / Form

Used for Arkansas IndependentChoices program, these templates are for Participant Summaries and Review Summaries.

This form is used for Arkansas' IndependentChoices program.

Standards required of Arkansas' fiscal management contractor. Includes descriptions of program deliverables and performance indicators.

Titled “Now You Have a Choice in Personal Care”, this tri-fold brochure was designed to be mailed without an envelope. The handout offers a program overview and provides a Request for Additional Information form.

Forms for Arkansas' IndependentChoices program. Source(s): Other, State Grantee

Includes a Backup Worker form, a Changing/Adding a Worker form, and a Worker Address and Phone Number form. In addition, there is an Employment Application and Personal Care Assistant Agreement form available.

An excel spreadsheet used to track a participant's hours of personal care and other expenditures for their monthly allowance.

Includes a self-assessment, self-assessment of personal care needs, and personal care assessment tools.

Liability issues pertaining to consumer-directed personal assistant services are discussed in this report. Issues are divided into topics including consumer-worker relationships, the risk of fiscal agents, the risk of consultants, and the risk for states and government entities. The report goes onto provide options to address liability risks.

This document from the Central Texas VDHCBS program contains templates for the veteran's action plan and participant-directed purchases. This worksheet helps develop an action and spending plan.