Follow the steps to successfully complete your application online.

1. Press the ‘Get Form’ button to obtain the application form and open it in your preferred online document editor.
2. Complete the Facesheet section, providing necessary information about the state requesting the waiver, including your contact details and the type of request (initial request, amendment, or renewal).
3. In Section A, Waiver Program Description, provide details regarding the waiver program overview, including the program description and the populations that will be affected by it.
4. Fill out Part I, ensuring you address the required subsections such as Tribal Consultation, Program Description, Waiver Services, and statutory authority.
5. Complete Part II, which includes Access, Provider Capacity, and Utilization Standards, defining how the state will monitor access and evaluate provider capacity.
6. Proceed to Part III, where you will detail Quality Standards and Contract Monitoring, describing how compliance with quality standards will be monitored.
7. Finalize the application by reviewing Section B that focuses on Waiver Cost-Effectiveness and Efficiency, and ensure all sections have been filled in correctly.
8. Once you have completed the form, you can save the changes you made, download a copy for your records, print the document if needed, or share it with the relevant parties.

Start filling out your CT Application for Section 1915(b) (4) Waiver Fee-for-Service Selective Contracting Program online today!