Get Family Support / Respite Services - I Am Boundless

Filling out the Family Support / Respite Services - I Am Boundless form online is a straightforward process designed to help families secure respite services for individuals in need. This guide provides clear, step-by-step instructions to ensure all necessary information is accurately provided.

Follow the steps to complete the form effectively.

1. Click the 'Get Form' button to access the document and open it in the editing interface.
2. Select the type of provider you wish to identify by checking the appropriate box. Choose either 'Private Respite Provider' or 'Counseling, Training and Education.' Only one option can be selected.
3. In the 'Provider Information' section, type or print clearly the family name requesting the provider, followed by the selected provider's name.
4. If the individual receiving services is a minor, the signature of their parent or guardian must be provided.
5. Complete the provider’s social security number and company name if applicable. Ensure you also fill in the federal ID number if the provider is new and requires a W-9 form.
6. Input the provider’s address, including city, state, and zip code, along with contact numbers for both the provider and their workplace.
7. Detail the type of service provided, and document any past experience the provider has in delivering the service.
8. Elaborate on any certifications or training the personnel for the selected provider might have.
9. Indicate the provider's hourly or quarter-hour charge.
10. Both the provider and the family requesting the caregiver must sign and date the form in the designated areas.
11. Verify that all required information is completed, including signatures, and ensure only one provider is identified.
12. If applicable, submit W-9 forms for new CTE providers or new company providers along with the form. Once completed, send the form to Family Support & Respite Services at the specified address.

Start filling out your Family Support / Respite Services - I Am Boundless form online today!