Get Pa 1923 - Cw Treatment Service Verification Rev 04-08doc - File Lacounty 2020-2025

This guide provides a comprehensive overview of how to effectively complete the PA 1923 - CW Treatment Service Verification form for the County of Los Angeles, ensuring a smooth online filing process.

Follow the steps to fill out the form accurately online.

1. Click the ‘Get Form’ button to access the form and open it in the appropriate online editor.
2. In Section A, provide your name and title as the authorized personnel from the treatment/service provider agency. Include the date of signing and your contact details.
3. Move to Section B and enter the participant's identification details, including their first and last name, Social Security Number, and DPSS Case Number.
4. In Section C, specify the substance abuse and/or mental health services being provided, including whether the participant is receiving services more than 32 hours per week and if they can participate in other Welfare-to-Work activities.
5. If applicable, detail any domestic violence case management and/or legal services in Section D, including expected service duration and hours per week.
6. In Section E, list any additional supportive service needs like childcare, transportation, and ancillary work-related expenses.
7. In Section F, indicate any recommended services ordered by the court system.
8. In Section G, the participant must provide their authorization by signing the appropriate line to allow verification of their case information.
9. Finally, review all provided information for accuracy and save your changes. You can then download, print, or share the completed form.

Complete the PA 1923 - CW Treatment Service Verification form online today!