Get Apply To The Olmstead Transition And Diverison Program - Wvdhhr

This guide provides detailed instructions on completing the Apply To The Olmstead Transition And Diversion Program application online. It is designed to assist users in understanding each section of the form and ensuring all necessary information is accurately provided.

Follow the steps to successfully complete your application.

1. Press the ‘Get Form’ button to access the application form and open it in your preferred editor.
2. Begin by entering the date when you completed the application. Then, provide the applicant's first and last name along with their date of birth.
3. In the section labeled 'Current Living or Residential Setting,' select the appropriate option that indicates where the applicant is currently residing, such as a nursing facility or their own home.
4. Fill in the applicant's street address, city, state, zip code, county, and telephone number. If applicable, include the facility name and admission date.
5. Answer the 'Tell Us About Yourself' section by responding 'yes' or 'no' to the statements provided, giving a clear picture of the applicant's health status and support needs.
6. In the 'Applicant Disability Status' section, list any diagnoses and check relevant conditions such as mental illness or dementia.
7. Provide income and services information by indicating Medicaid and Medicare membership status, and detailing the applicant's total monthly income and sources.
8. If a legal representative is completing the form, indicate their type and provide their name, relationship to the applicant, and contact information.
9. In the funding request proposal section, clearly state the amount of funding requested and include detailed estimates from vendors or contractors, along with their contact information.
10. Complete the certification and authorization section by signing the application. Ensure that signatures are obtained from both the applicant and, if applicable, their legal representative.
11. Once the application is fully completed, return it as instructed — either by fax, email, or through the specified postal address.

Complete your application online to access vital support through the Olmstead Transition And Diversion Program.