Get Cover Sheet State: Arkansas Title Of Waiver Program: Non-emergency Transportation 1915(b)(4) Waiver

Filling out the Cover Sheet for the Arkansas Non-Emergency Transportation Waiver is an essential step in securing necessary transportation services. This guide provides a clear and user-friendly approach to completing the form online, ensuring that users can navigate each section with confidence.

Follow the steps to complete the online form accurately.

1. Click the ‘Get Form’ button to obtain the form and open it.
2. Complete the header section by entering the State and the Title of the Waiver Program. Specify 'Arkansas' and 'Non-Emergency Transportation 1915(b)(4) Waiver'.
3. Fill in the Waiver Number as 'AR 0003' and select the Type of Request as '2-Year Renewal of Non-Emergency Transportation 1915(b)(4) Waiver'.
4. Indicate the Proposed Effective Date, which should be the first day of the waiver period, and ensure it aligns with the due renewal date.
5. Input the Proposed End Date, which will typically be the last day of the waiver period, ensuring that it reflects the correct timeframe.
6. In the State Contact section, provide the name, phone number, and email address of the designated contact person responsible for the waiver negotiations.
7. Address the Request Information and check 'A' to confirm that the state is requesting a waiver under authority section 1915(b) of the Act.
8. For the Program History section, briefly summarize the history of the Non-Emergency Transportation services as per the provided guidelines.
9. Review all entries to ensure accuracy and consistency before finalizing your form.
10. Once completed, proceed to save your changes, download the form, print, or share as necessary.

Begin filling out your form online today to ensure timely processing of your waiver application.