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Get NY Service Amendment Request Form 2023-2024
Ormation, see pages 8 & 9 of this form): Adding an additional HCBS waiver service: Individual is requesting to add a new HCBS waiver service. Do not use this form for service(s) previously authorized. Increasing service amount: Individual requesting an increase in service amount for an existing HCBS waiver service Changing provider: Individual is notifying DDRO of a change in provider INSTRUCTIONS: Please provide all information requested below. If you have any questions or need as.
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