Application Caregiver Form With Child In Franklin

State:
Multi-State
County:
Franklin
Control #:
US-00458BG
Format:
Word; 
Rich Text
Instant download

Description

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.
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  • Preview Personal Care Service Agreement - Caregiver for Elderly or Disabled - Consent
  • Preview Personal Care Service Agreement - Caregiver for Elderly or Disabled - Consent

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FAQ

Our Services Family SizeMaximum Monthly Income Limit for Initial Eligibility (145%)Maximum Monthly Income Limit for Special Need Eligibility (150%) 2 $2,470 $2,555 3 $3,120 $3,228 4 $3,770 $3,900 5 $4,421 $4,5733 more rows

Please find below a brief outline of the Income Eligibility Standards: Family Size2021 Federal Poverty Level (100%)Maximum Income Limit for Ongoing Eligibility (300%) 2 $1,452 $4,355 3 $1,830 $5,490 4 $2,209 $6,625 5 $2,587 $7,760

Phone: 1-844-640-OHIO (6446) If you have inquiries concerning your Child Care, Medicaid, Food Assistance or general status information, our Customer Access Center will be able to assist you.

State Fiscal Year 2024–25 Schedule of Income Ceilings FAMILY SIZE1-26 Family Yearly Income Ceiling (100% of SMI) $79,143 $137,998 Family Yearly Monthly Ceiling (100% of SMI) $6,595 $11,500

What are the income and eligibility guldelines? Assistance Group Size130% FPL Gross Monthly Income Standard 1 $1632 2 $2215 3 $2798 4 $33808 more rows

WIC Qualifications Economic UnitAnnualBiweekly 1 $27,861 $1,072 2 $37,814 $1,455 3 $47,767 $1,838 4 $57,720 $2,22012 more rows

What are the minimum qualifications to become a Family Child Care Provider? Have a high school diploma or GED. Be at least 18 years of age. Pass a home inspection. Pass local, FBI and BCII background checks. Pass a Franklin County Children Services request for Child Abuse and Neglect Report.

Please note: Anyone can provide care for no more than 6 children or no more than 3 children under the age of 2 years in their home without a license. However, in order to receive payment for serving families eligible for PFCC, the Type B home provider must be licensed by ODJFS.

These are the eligibility requirements: Children must be under the age of 13, or if they have special needs, under the age of 18. Your initial gross monthly household income for your family size must be equal to or less than 145% of the Federal Poverty Level (FPL).

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Application Caregiver Form With Child In Franklin