• On-Line Security Request (Security Affidavit) (fill-in)
  

• DDP Portal Account Renewal Form
  

• Instructions and Definitions
• Page1 Application DODD Nurse CEU
• Page 2 Faculty and Qualification DODD Nurse CEU L
• Page 3 Behavior Outcomes for Training Session DODD Nurse CEU Application
• Page 4 Independent Study Application DODD Nurse CEU Application
• Sample Evaluation Form
  
• Sample OBN Certificate of CE
• Sample Attendance Doc
• Applicant Submission Checklist
  
• Committee Review of CE Presentation

• Application for College-University Course Approval
  
• Seminar Approval
• County Board Training Approval Form
• Attendance Verification of Department-Approved Training for CPD Units
• Verificatio​​n of Environmental Modifications
• County Board Application for Certification
• Application Addendum

*The individual Attendance Record Template is no longer available​

• Level One Prescreening Tool​
• Freedom of Choice Document
  
• Clinician Verification Form 10 and Up
• Clinician Verification Form Birth to Age 9
  

• Level One Prescreening Tool 

• Incidents Adversely Affecting Health and Safety & Behavior Support 

• Informal R​espite Services Forms

• Designation of Local Match Form

• County Board Funded BAO Eligibility Assessment Form

• Bridge Funding Invoice
  

• ICF-IID Exit Waiver One Time SSA Funding

• Authorization in Excess of Budget Limitation
  

• Notice of Approval of Your Application for Assistance
  

• ODDP Tool
  

• Instructions for Completing the ODDP
  

• State Healthchek Plan Referral form (ODM 10124)
  

• Private Duty Nursing (PDN) request form (ODM 02374)
  

• Participant Directed HPC Acknowledgment 
  

• PASRR Evaluation Summary
  

• PASRR (SMI / DODD) Identification Screen
  

• PASRR Movement Form
  

• PA Request Form

• PA Request Form Page 2​

• BAO Submission Form​

• BAO Updated Information

• State-funded Behavior Add-on FAQ's

• Skilled Nursing Task Assessment Form

• Nursing Task Assessment Form - Completion Guidelines

•  Provider Request for Associaiton with Billing Agent
  

• New Vendor Information Form
  

• IRS W-9 Tax Identification Form
  

• 001 90 Day Notification
• 001F Individual Sample Key
• 002 Email Review Confirmation
• 002F Staff Sample Key 
• 003 E-mail SSA Notification
  
• 004 Agency Tool
  
• 005 ICFIID Tool
  
• 006 Independent Tool
  
• 007 Ancillary Required Documents List
• 008 Ancillary Services Tool
  
• 008 POC Approval Letter
• 008F Plan of Correction
• 009 Licensure POC Approval Letter
• 009F POC-V
• 010 DC POC Approval Letter
• 011 POC Disapprocval Letter
• 011F Sample Size Protocol 
• 012F Ancillary Required Documents List 
  
• E-Mail Compliance Report Cover               
• 013F Accreditation Required Documents List
  
• 014F Independent Required Documents List
  
• 015F Agency Required Documents List
  
• 016F ICFIID Required Documents List
  
• 017F License Provider Required Documents List
  
• 018F Immediate Correction Form
• 019F Exit Conference Record
  
• 019G Exit Conference Guidelines
• 022 E-Mail Licesnsure No Sites - POC Approval 
• 025 IO Individual Interview Tool
  
• 026 L1 Individual Interview Tool
  
• 027 SELF Individual Interview Tool
  

• Pre-Admission Counseling Referral Form
• Pre-Admission Counseling Guidance

This short video offers an overview of the pre-admission counseling process and accompanying form.

• Pre-Admission Counseling Job Aid

•  Compliance Review Protocol New

• Addendum A - Service Selection and Estimates
• Addendum B - FFATA Information
• Addendum C - Award Information and Allocation Table
• EXHIBIT A - Program Goals and Service Definitions
• EXHIBIT B - Unit of Service Log (DODD 1017) Examples
• EXHIBIT C - TXX Certification of Proper Billing
• EXHIBIT D - General Service Provisions
• EXHIBIT E - Quarterly Reporting TXX Online Application Invoicing
• EXHIBIT F - 42 U.S.C. 1397d, Limitations on Use of Grants
• TXX FY18-19 County Board Grant Agreement