Follow the steps to complete the form effectively.

1. Click ‘Get Form’ button to obtain the form and open it in the designated editor.
2. Complete the first section, providing your client name, PMI number, and fiscal intermediary information. Ensure that each entry is accurate and formatted correctly.
3. Fill in the fields for the person completing the addendum, including their name, date of birth, case manager’s name, agency, and support planner’s name.
4. Specify the waiver span in the corresponding field to clarify the duration for which the changes apply.
5. In the designated area, list the changes you wish to make to your plan. Be clear and concise about each change and its specific reason.
6. Indicate the expected outcome from the changes in the given field. This helps outline the intended benefits of your request.
7. Provide details regarding the cost of the change and any associated FMS fees, filling in these specific financial figures as applicable.
8. Clarify the source of funding for the changes by indicating where the necessary funds will be allocated from.
9. Ensure to acquire supervisor or lead agency approval by having them sign and date the provided space at the end of the form.
10. Lastly, include the signatures of the participant or guardian, as well as the case manager, along with the respective dates.
11. Once you have completed all sections, save changes to the document and proceed to download, print, or share the form as necessary.

Take the next step in managing your community support plan by completing the MN Addendum online today.