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Thank you for completing the Universal Intake Form (UIF). Our services are free to all who qualify.Please fill out the intake form to verify your eligibility for any of our programs. Completed By: First Name. Follow this simple instruction to edit UNIVERSAL INTAKE FORM 1 - css lacounty in PDF format online at no cost: Register and sign in. • Better able to identify client needs with. Intake. The purpose of the Authorization Form is to enable agencies identified as members of the Chautauqua. Universal Initial Intake Form. HC11527. Rev. Form 610 V9-24-12 Page 1. 1. Social Security Number(SSN).