Get Cdassauthorized Representative Screening Questionnaire2015 - Colorado

Filling out the CDASS Authorized Representative Screening Questionnaire is a crucial step for individuals interested in receiving Consumer Directed Attendant Support Services in Colorado. This guide will provide you with detailed, step-by-step instructions to complete the questionnaire online with ease.

Follow the steps to fill out the questionnaire accurately and efficiently.

1. Press the ‘Get Form’ button to access the questionnaire and open it in your preferred editor.
2. Begin by filling out the 'Client Information' section. Enter the full name of the client who is seeking Consumer Directed Attendant Support Services.
3. Proceed to the 'Authorized Representative Questionnaire' section. Here, check the box that best describes your relationship to the client, selecting one of the options: Family Member, Friend, Legal Guardian, or Other.
4. In the next question, indicate whether you receive money from the client or anyone else for caring for the client by checking 'Yes' or 'No'. If you select 'Yes', provide the details about who pays you and the purpose.
5. Indicate your willingness to sign the Client or Authorized Representative Responsibilities Form by checking 'Yes' or 'No'.
6. After reviewing the Authorized Representative description, confirm your understanding and willingness to serve as the client’s Authorized Representative by selecting 'Yes' or 'No', after initialing the description.
7. Acknowledge that as the Authorized Representative, you cannot be both a paid attendant and the Authorized Representative by selecting 'Yes' or 'No'.
8. Complete the 'Authorized Representative Name (Printed)' section, signing your name as required.
9. Fill in the rest of your contact information, including your address, city, home phone number, cell phone number, date, state, and zip code.
10. Once all sections are completed, review your responses for accuracy. You can then save any changes, download the completed form, print it, or share it as necessary.

Take the next step by completing your CDASS Authorized Representative Screening Questionnaire online today.