Get Liss Request Form 2014-2025

The LISS Request Form is essential for individuals seeking financial assistance for support services related to developmental disabilities. This guide provides a systematic approach to filling out the form online, ensuring users can complete it accurately and efficiently.

Follow the steps to effectively complete the LISS Request Form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. In Section 1, familiarize yourself with the program information. This section outlines the purpose of LISS, eligibility criteria, and potential support services and items available. Make sure you have all required documentation.
3. Proceed to Section 2 to fill out the applicant information. Provide your last name, first name, middle name, street address, city, email address, and date of birth. Ensure that your contact details are accurate.
4. Still in Section 2, enter your county, telephone number, social security number, medical assistance number, and the date of application if applicable. This information is crucial for your eligibility assessment.
5. Move to Section 3 where you will detail the service or item you are requesting. Write the name and address of the vendor or service provider.
6. In Section 4, fill in request information, which includes the telephone number of the vendor or service provider, the cost of the service or item, and any relevant date(s) of service. If applicable, include the daily or hourly rate along with the amount of days or hours required.
7. Before submitting the request, complete the applicant checklist. Gather and ensure the readability of the necessary documents: a copy of the social security card, proof of address, proof of developmental disability, and an estimate or invoice.
8. In Section 5, you must sign the applicant declaration. By signing, you attest to the accuracy of the information provided. If you are completing this on behalf of another person, include your name and contact information as required.
9. Finally, review all entered information for accuracy, save changes, and proceed to download, print, or share the form as required for submission.

Complete your LISS Request Form online today to receive the support services you or your loved one may need.