Get Form M-13d (page 1) - Nyc

Filling out the Form M-13d is a crucial step in applying for the Consumer Directed Personal Assistance Program. This guide will walk you through each section of the form to ensure that you can complete it accurately and confidently, facilitating your application process.

Follow the steps to accurately complete the form online.

1. Press the 'Get Form' button to access the form and open it in your preferred online editor.
2. Begin with Section 1a, which requires consumer identifying information. Fill in the consumer's surname, first name, middle initial, address, age, date of birth, and telephone number. Ensure to include the correct Medicaid number and Social Security number.
3. In the Living Arrangements section, select from available choices such as 'One Family House' or 'Apartment' and indicate additional details as necessary, such as the number of flights in a walk-up.
4. Next, proceed to Section 1b to provide information about the parent, legal guardian, or designated representative. Fill out their name, address, and relationship to the consumer, along with contact details.
5. Fill in the consumer's next of kin details, including their name, relationship, and contact information in Section 2.
6. Section 3 requires you to provide a back-up representative’s details. Ensure this person is available to maintain significant contact and is able to complete subsequent sections.
7. In Section 4, describe the consumer's medical condition and personal situation as required, providing comprehensive details to support your application.
8. Complete Section 5 by outlining the screening and recruitment plan, including how personal assistants will be recruited and trained.
9. In Section 6, the consumer or representative must read the declaration statement and provide a signature, relationship to the consumer, and the date of signing.
10. Review all entered information for accuracy. Once confirmed, you can save your changes, download, print, or share the completed form online as necessary.

Complete your forms conveniently online and ensure a smooth application process.