Get Pa Dp 1024 2012-2025

The PA DP 1024, or Provider Vacancy Notification Form, is an essential document for reporting vacancies in residential habilitation settings. This guide will provide you with clear, step-by-step instructions on how to effectively complete this form online, ensuring timely reporting and compliance with regulatory requirements.

Follow the steps to successfully complete the form online.

1. Click ‘Get Form’ button to access the form and open it in the online editor.
2. Begin by entering the provider information. Include the legal entity name, street address, city, state, zip code, and phone number with area code. Fill in the MPI number, program capacity, site location code, and licensed capacity.
3. In the next section, specify the residential site information. Enter the residential site name, street address, city, state, and zip code.
4. Identify the responsible administrative entity (AE) and enter the date of the vacancy in the format mm/dd/yyyy. Select the reason for the vacancy from the provided options.
5. If any internal moves are being planned, attach the movement plan detailing the names of individuals expected to move, reasons for the move, affected service locations, projected move dates, and the location of the vacancy resulting from the moves.
6. Provide information for the individual associated with the vacancy by entering their name, MCI number, county of registration, and waiver status.
7. Complete the submission by filling in your name, provider name, contact person, phone number, email address, and the date of the request in mm/dd/yyyy format.
8. Ensure all sections are filled accurately. After reviewing, save your changes. You can then download, print, or share the completed form as required.

Start filling out the PA DP 1024 online today to ensure prompt reporting of vacancies.