Get Service Amendment Request Form

Completing the Service Amendment Request Form online can be a straightforward process if you follow the right steps. This guide will provide you with a clear pathway to ensure your information is accurately submitted for the requested service amendments.

Follow the steps to complete the form effectively.

1. Click the ‘Get Form’ button to obtain the Service Amendment Request Form. Make sure to open it in the desired online editor for easy filling.
2. Begin by filling in your personal information. This includes your full name, date of birth, TABS ID number, and contact details such as your address, phone number, and email.
3. Indicate your current living situation and provide information for the primary contact person, including their relationship to you.
4. Enter details about your current services, including the service type, provider name, and the amounts currently authorized and received. This helps outline your existing support.
5. If applicable, specify any OPWDD services you are requesting to drop or reduce. Clearly identify these based on the services you wish to amend.
6. Complete the sections for the services you are requesting, including community habilitation, day habilitation, or any other relevant services. Be sure to check all types of requests and provide justification for each service request.
7. If employed, provide information regarding your job and the anticipated start date of the services requested.
8. Ensure that a care manager reviews the form and provides their signature, confirming that a person-centered discussion has taken place regarding the service needs.
9. Final steps include saving your changes, downloading your completed form, and preparing to submit it electronically via the specified email address.

Ensure your service amendment requests are submitted online efficiently by following these steps carefully.