Get Va Commonwealth Coordinated Care Plus Attendant Application Request 2019-2025

This guide provides clear, step-by-step instructions on how to complete the VA Commonwealth Coordinated Care Plus Attendant Application Request online. Whether you are a new or existing attendant, securing your role in this program begins with accurately filling out this important document.

Follow the steps to complete the application accurately.

1. Press the ‘Get Form’ button to access the application form and open it for editing.
2. Begin by answering the program qualifications section. You must respond to each question regarding your relationship with the individual receiving waiver services. If you answer 'Yes' to any of these questions, you will not qualify for employment in this program.
3. If you are not choosing electronic enrollment, all new or existing attendants must complete this form if you are applying to work for a new or additional consumer. It is essential to provide a physical street address as well as a mailing address.
4. Fill in the required personal information for the attendant including first name, middle name, last name, date of birth, street address, phone number, Social Security number, city, state, zip code, and email address.
5. Provide your expected date of employment, and if desired, additional optional information for the criminal background check, including gender and race.
6. Complete the consumer information section by providing the consumer's first name, last name, and the employer of record's (EOR) information, including their first and last name, phone number, email address, and consumer ID.
7. Review all entered information for accuracy before submitting. Make sure all required fields are completed.
8. Submit the completed form by faxing it to 1-866-709-3319 or emailing it to vapplfax@pcgus.com. Allow up to 3 business days for processing.
9. Once processed, VA CCC Plus will send the attendant hire packet to the employer via mail or secure email within 3 business days.

Begin filling out the VA Commonwealth Coordinated Care Plus Attendant Application Request online now to ensure a smooth application process.