Get Form 02as003e (ads-ra-1) Instructions - Okdhs

Filling out the Form 02AS003E (ADS-RA-1) online can be an efficient way to request adult day services. This guide will walk you through each section of the form, ensuring you have the necessary information and support to complete it accurately.

Follow the steps to successfully complete the form.

1. Press the ‘Get Form’ button to access the form and open it in your preferred editor.
2. In the participant information section, provide the applicant's identifying details, including the spouse's information if applicable. Make sure to include the OKDHS case number if the applicant is already receiving services.
3. Fill out the authorized representative information if the applicant has one. Ensure to enter accurate contact details for the representative.
4. Record the applicant's and spouse's gross monthly income from all sources in the income documentation section. List the documentation used to verify each income source clearly.
5. Understand that the income computation section is to be completed solely by the county office. If the applicant is already receiving OKDHS assistance, they will be deemed predetermined eligible.
6. In the responsibilities section, the applicant must read, sign, and date page 4 to acknowledge understanding and acceptance of their responsibilities. If reading or writing is an issue, the authorized representative may sign the application on their behalf.
7. Once completed, ensure the adult day services center submits the form with the attached income documentation to the Aging Services Division, Attention: Adult Day Services. The applicant should receive a copy for their records.
8. If the adult day services center generated the application, they should retain a copy, while the original form will be imaged into the participant's record at OKDHS.
9. After completing all fields, save your changes, download the form, or print it for submission.

Start filling out your documents online today to ensure a smooth application process.