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South Carolina Department of Disabilities and Special Needs Forms

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Informacion Individual Del Contacto - South Carolina (Spanish) PDF

Informacion Individual Del Contacto - South Carolina (Spanish)
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Individual Contact Information - South Carolina PDF

Individual Contact Information - South Carolina
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Appendix A Icf/Id Cost Report Format Checklist of Supplemental Schedules and Documentation - South Carolina PDF

Appendix A Icf/Id Cost Report Format Checklist of Supplemental Schedules and Documentation - South Carolina
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Attachment A Statement of Financial Rights (For Persons Receiving Residential Services) - Sample - South Carolina PDF

Attachment A Statement of Financial Rights (For Persons Receiving Residential Services) - Sample - South Carolina
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Attachment B Fee Schedule (For Recipients of Residential Services) - Sample - South Carolina PDF

Attachment B Fee Schedule (For Recipients of Residential Services) - Sample - South Carolina
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Attachment C Physician Certification/Efforts to Locate Person Form - Sample - South Carolina PDF

Attachment C Physician Certification/Efforts to Locate Person Form - Sample - South Carolina
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Attachment C Residency Agreement for Residence Controlled by a Provider - Sample - South Carolina PDF

Attachment C Residency Agreement for Residence Controlled by a Provider - Sample - South Carolina
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Attachment A Personal Property Record - Items Valued at $100.00 or More - Inventory - Sample - South Carolina PDF

Attachment A Personal Property Record - Items Valued at $100.00 or More - Inventory - Sample - South Carolina
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Attachment A Statement of Financial Rights - Sample - South Carolina PDF

Attachment A Statement of Financial Rights - Sample - South Carolina
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Appendix A Id/Rd Hcb Waiver Cost Report Format Checklist of Supplemental Schedules and Documentation - South Carolina PDF

Appendix A Id/Rd Hcb Waiver Cost Report Format Checklist of Supplemental Schedules and Documentation - South Carolina
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Attachment A Past Due Payment Agreement - Sample - South Carolina PDF

Attachment A Past Due Payment Agreement - Sample - South Carolina
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Attachment B Arrc Review Notification Letter - Sample - South Carolina PDF

Attachment B Arrc Review Notification Letter - Sample - South Carolina
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Ddsn - Information Appointment Sheet - South Carolina PDF

Ddsn - Information Appointment Sheet - South Carolina
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Attachment C Arrc Decision/Appeal Notification Letter - Sample - South Carolina PDF

Attachment C Arrc Decision/Appeal Notification Letter - Sample - South Carolina
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Information Technology Procurement Request - Sample - South Carolina PDF

Information Technology Procurement Request - Sample - South Carolina
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Attachment A Residential Respite Approval - Sample - South Carolina PDF

Attachment A Residential Respite Approval - Sample - South Carolina
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Appendix A H&SCI Hcb Waiver Cost Report Format Checklist of Supplemental Schedules and Documentation - South Carolina PDF

Appendix A H&SCI Hcb Waiver Cost Report Format Checklist of Supplemental Schedules and Documentation - South Carolina
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Attachment A Initial Event Notification - Sample - South Carolina PDF

Attachment A Initial Event Notification - Sample - South Carolina
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Attachment B Residential Vacancy Report - Sample - South Carolina PDF

Attachment B Residential Vacancy Report - Sample - South Carolina
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Attachment B Initial Event Notification Sc Dhec Icf/Id Facilities - Sample - South Carolina PDF

Attachment B Initial Event Notification Sc Dhec Icf/Id Facilities - Sample - South Carolina
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Attachment A Annual Facility Inspection Report - General Building Inspection - Sample - South Carolina PDF

Attachment A Annual Facility Inspection Report - General Building Inspection - Sample - South Carolina
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Attachment E Fire Sprinkler Systems Semi-annual Waterflow Alarm Test Form - Sample - South Carolina PDF

Attachment E Fire Sprinkler Systems Semi-annual Waterflow Alarm Test Form - Sample - South Carolina
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Attachment D Fire Sprinkler Systems Monthly and Quarterly Inspection Form - Sample - South Carolina PDF

Attachment D Fire Sprinkler Systems Monthly and Quarterly Inspection Form - Sample - South Carolina
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Attachment G Hvac Inspection Check List - Sample - South Carolina PDF

Attachment G Hvac Inspection Check List - Sample - South Carolina
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Appendix A Community Supports Waiver Cost Report Format Checklist of Supplemental Schedules and Documentation - South Carolina PDF

Appendix A Community Supports Waiver Cost Report Format Checklist of Supplemental Schedules and Documentation - South Carolina
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Attachment D Application for Benefits and Management of Funds Authorization for Recipients of Residential Services - Sample - South Carolina PDF

Attachment D Application for Benefits and Management of Funds Authorization for Recipients of Residential Services - Sample - South Carolina
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Cash Ledger for Funds Maintained at Residential Level - Sample - South Carolina PDF

Cash Ledger for Funds Maintained at Residential Level - Sample - South Carolina
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Attachment A Application to Operate Residential, Day, Respite or Camp Facility - Sample - South Carolina PDF

Attachment A Application to Operate Residential, Day, Respite or Camp Facility - Sample - South Carolina
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Attachment 2 "schedule 14" to the Capital Application - Summary of Final Purchase/Construction/Renovation Costs - Sample - South Carolina PDF

Attachment 2 "schedule 14" to the Capital Application - Summary of Final Purchase/Construction/Renovation Costs - Sample - South Carolina
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Attachment 5 Addendum "c" to Capital Application - Zoning Letter - Sample - South Carolina PDF

Attachment 5 Addendum "c" to Capital Application - Zoning Letter - Sample - South Carolina
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Attachment 4 Addendum "b" to Capital Application - Justification of Purchase/Construction of a Particular Facility - Sample - South Carolina PDF

Attachment 4 Addendum "b" to Capital Application - Justification of Purchase/Construction of a Particular Facility - Sample - South Carolina
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Attachment 3 Surveillance Video Camera Recording Release Record - Sample - South Carolina PDF

Attachment 3 Surveillance Video Camera Recording Release Record - Sample - South Carolina
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Attachment 10 Addendum H to Capital Application - Fire Sprinkler System Information for Ddsn Projects - Sample - South Carolina PDF

Attachment 10 Addendum H to Capital Application - Fire Sprinkler System Information for Ddsn Projects - Sample - South Carolina
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Attachment 6 Addendum "d" to Capital Application - Work Write-Up - Sample - South Carolina PDF

Attachment 6 Addendum "d" to Capital Application - Work Write-Up - Sample - South Carolina
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Application - Competitive Funding for Special Service Contract: Statewide Consumer/Family Support Networks - Sample - South Carolina PDF

Application - Competitive Funding for Special Service Contract: Statewide Consumer/Family Support Networks - Sample - South Carolina
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Attachment B Request for Exception Form - Sample - South Carolina PDF

Attachment B Request for Exception Form - Sample - South Carolina
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Attachment F Generator Inspection Check List - Sample - South Carolina PDF

Attachment F Generator Inspection Check List - Sample - South Carolina
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Attachment A Service Letter - Sample - South Carolina PDF

Attachment A Service Letter - Sample - South Carolina
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