Get Ia Dhs 470-5583 2020-2026

The IA DHS 470-5583 form is a crucial document for individuals seeking home- and community-based services under the Brain Injury Waiver. This guide will provide you with a comprehensive walkthrough on how to fill out this form online, ensuring that you understand each section and can complete it accurately.

Follow the steps to complete the IA DHS 470-5583 form online.

1. Click ‘Get Form’ button to access the IA DHS 470-5583. This action will allow you to open the form in an interactive format for completion.
2. Begin by entering your personal details. Fill in your name, date of birth, and social security number or state ID. Ensure all information is accurate and current.
3. Next, assess and check all applicable emergency need criteria from the list provided. This section requires you to detail the reasons for your application, such as the unavailability of caregivers or the risk of losing housing. Be sure to provide any necessary explanations on the next page.
4. Following the emergency need criteria, you will find the urgent need criteria. Again, check all that apply and provide detailed information where necessary. This section addresses your current living situation and any risks or needs that require urgent attention.
5. After completing the criteria sections, count the total number of checked items for both emergency and urgent needs and write these totals in the designated spaces.
6. Complete the 'Emergent and Urgent Need Detail' section if additional space is needed. You may use the back of the page or an extra sheet of paper if required.
7. The next step is to fill out the assessment completed by section. Print your name, sign, and provide your contact phone number and relationship to the applicant.
8. Lastly, once all sections are filled out accurately, review your form for any errors or missing information. You can then save your changes, download, or print the completed form for submission.

Complete your IA DHS 470-5583 form online today to ensure timely processing of your application.