This form is a sample of an agreement between an elderly or disabled client and a Caregiver who operates as an independent contractor and provides personnel to assist Client to live at home and to have as much control over the home environment and life as possible under the circumstances. Caregiver's personnel also assist Client with the activities of daily living, scheduling medication, assistance with mobility, accompanying Client on errands and appointments, and such other services as agreed between Client and Caregiver.
In this agreement, Client waives damages for simple negligence of Caregiver, but not gross negligence or misconduct that is intentional or criminal in nature. Courts generally will not enforce waivers of this type of misconduct since such a waiver would be deemed to be against public policy because it would encourage dangerous and illegal behavior.
Application Caregiver Form With Decimals In Bronx
Category:
State:
Multi-State
County:
Bronx
Control #:
US-00458BG
Format:
Word;
Rich Text
Instant download
Description
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FAQ
Eligibility Guidelines Family Size85% SMI for New York Monthly Income85% SMI for New York - Income Standards 1 $4,707.37 $56,488.48 2 $6,155.80 $73,869.56 3 $7,604.22 $91,250.63 4 $9,052.64 $108,631.706 more rows •
To Apply for CCAP you must complete the New York State Application for Certain Benefits and Services (LDSS-2921). This form can also be obtained from your LDSS.
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Apply for AM-NYC (Bronx)-Caregivers. Please fill out the form below and click Submit to submit your application for consideration.