Get Sfn 1177

The SFN 1177 is a crucial form used to request guardianship establishment funds through the North Dakota Department of Human Services. This guide provides clear, step-by-step instructions to assist users in completing the form accurately and efficiently online.

Follow the steps to fill out the SFN 1177 form online.

1. Click ‘Get Form’ button to obtain the form and open it in the online editor.
2. Begin by providing consumer demographic information. Fill out the name, ROAP ID number, date of birth, MA number, and address details, including city, state, and ZIP code. If the residential address is the same as the mailing address, check the corresponding box.
3. Indicate program eligibility by answering questions regarding the consumer's eligibility for developmental disabilities case management, their status as an incapacitated adult, and their income status in relation to the federal poverty level.
4. Complete the referral source/case manager section by inputting the name, telephone number, agency, address, email address, state, ZIP code, and fax number.
5. Check all required documentation that is attached, including evaluations, progress notes, physician's evaluations recommending guardianship, and other relevant documents.
6. Specify the recommended type of guardianship by checking all that apply: full, limited, or emergency guardianship. If applicable, list the specific areas pertinent to limited or emergency guardianship.
7. Provide the signatures of both the case manager and supervisor, including the date and telephone number for each.
8. In the reason for guardianship section, describe the justification for guardianship and how the consumer's disability impacts decision-making. Attach additional sheets if necessary.
9. Identify less restrictive alternatives to guardianship that have been tried and explain why they were insufficient.
10. Detail the consumer's net income, benefits, and assets. This includes listing monthly amounts for various forms of income and benefits, as well as detailing assets like bank accounts, property, and vehicles.
11. Complete the proposed guardian section by filling out their name, contact information, agency, and whether the proposed guardian agrees to take on the guardianship role.
12. Once all sections are complete, users can save changes, download, print, or share the form as needed.

Complete your SFN 1177 form online today to ensure timely processing of your guardianship establishment funds request.