Instructions for "Residential Property Approval and Authorization Form (Rpaa)" - Delaware

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Residential Property Approval and Authorization Form (RPAA) Instructions
INTRODUCTION: The Division of Developmental Disabilities Services (DDDS) requires contracted
residential habilitation providers to obtain preauthorization from the appropriate DDDS
representative before executing or renewing any lease or mortgage agreement.
Providers are responsible for submitting to the Office of Budget, Contract, & Business Services
(OBCBS) a complete and accurate Residential Property Approval and Authorization Form (RPAA) for
each residential property associated with a lease or mortgage agreement. Providers are strongly
encouraged to submit typed RPAA forms; the RPAA template contains drop-down boxes and fillable
spaces to facilitate this process. Additionally, please make sure that all RPAA forms are scanned
properly before submitting to OBCBS.
This document serves as resource for providers and contains section-specific guidelines for
accurately completing the RPAA.
Please note that within the RPAA, cells shaded in PINK indicate that the provider will select a
response using an embedded drop-down menu. Cells shaded in TAN indicate that the provider will
type a response directly into the fillable cell.
 LINE 1: Type the name of the Provider Agency
 LINE 2: Indicate whether the property represents a Community Living Arrangement or a
Neighborhood Group Home by using the drop-down menu to select the letter “P”. This will place
a check mark in the appropriate box.
For reference, a Neighborhood Group Home (NGH) is a provider managed residential setting that
requires licensure by the Division of Long Term Care Residents Protection. This setting is distinct
from a Community Living Arrangement and Family Rest Home (known as shared living). Typically two
to four individuals reside in NHs, however, DDDS exceptions may be granted due to extenuating
circumstances.
A Community Living Arrangement (CLA) is a provider managed residential setting that does not
require licensure by the Division of Long Term Care Residents Protection which may include
apartments, condominiums, and townhomes. A CLA does not meet the category of neighborhood
home, shared living, or assisted living.
LINE 3: Type street address, city, state, zip code, and county information. For county, please
indicate one of the following four options: Kent, Sussex, New Castle East or New Castle West.
Please refer to the chart below for regional split information for New Castle County.
Regional Split: New Castle County
New Castle East
New Castle West
19701
Bear
19702
Newark
19701
Claymont
19707
Hockessin
19706
Delaware City
19711
Newark
19708
Kirkwood
19712
Newark
19710
Montchanin
19713
Newark
Residential Property Approval and Authorization Form (RPAA) Instructions
INTRODUCTION: The Division of Developmental Disabilities Services (DDDS) requires contracted
residential habilitation providers to obtain preauthorization from the appropriate DDDS
representative before executing or renewing any lease or mortgage agreement.
Providers are responsible for submitting to the Office of Budget, Contract, & Business Services
(OBCBS) a complete and accurate Residential Property Approval and Authorization Form (RPAA) for
each residential property associated with a lease or mortgage agreement. Providers are strongly
encouraged to submit typed RPAA forms; the RPAA template contains drop-down boxes and fillable
spaces to facilitate this process. Additionally, please make sure that all RPAA forms are scanned
properly before submitting to OBCBS.
This document serves as resource for providers and contains section-specific guidelines for
accurately completing the RPAA.
Please note that within the RPAA, cells shaded in PINK indicate that the provider will select a
response using an embedded drop-down menu. Cells shaded in TAN indicate that the provider will
type a response directly into the fillable cell.
 LINE 1: Type the name of the Provider Agency
 LINE 2: Indicate whether the property represents a Community Living Arrangement or a
Neighborhood Group Home by using the drop-down menu to select the letter “P”. This will place
a check mark in the appropriate box.
For reference, a Neighborhood Group Home (NGH) is a provider managed residential setting that
requires licensure by the Division of Long Term Care Residents Protection. This setting is distinct
from a Community Living Arrangement and Family Rest Home (known as shared living). Typically two
to four individuals reside in NHs, however, DDDS exceptions may be granted due to extenuating
circumstances.
A Community Living Arrangement (CLA) is a provider managed residential setting that does not
require licensure by the Division of Long Term Care Residents Protection which may include
apartments, condominiums, and townhomes. A CLA does not meet the category of neighborhood
home, shared living, or assisted living.
LINE 3: Type street address, city, state, zip code, and county information. For county, please
indicate one of the following four options: Kent, Sussex, New Castle East or New Castle West.
Please refer to the chart below for regional split information for New Castle County.
Regional Split: New Castle County
New Castle East
New Castle West
19701
Bear
19702
Newark
19701
Claymont
19707
Hockessin
19706
Delaware City
19711
Newark
19708
Kirkwood
19712
Newark
19710
Montchanin
19713
Newark
19720
New Castle
19714
Newark
19721
New Castle
19715
Newark
19730
Odessa
19716
Newark
19731
Port Penn
19717
Newark
19732
Rockland
19725
Newark
19733
Saint Georges
19726
Newark
19734
Townsend
19735
Winterthur
19801
Wilmington
19736
Yorklyn
19802
Wilmington
19807
Wilmington
19803
Wilmington
19808
Wilmington
19806
Wilmington
19880
Wilmington
19804
Wilmington
19805
Wilmington
19809
Wilmington
LINE 4A: Indicate whether the property is ADA-accessible by using the drop-down menu to select the
letter “P”. This will place a check mark in the appropriate box. For clarification on ADA accessibility
consult https://www.ada.gov/2010ADAstandards_index.htm.
Please note that if “Yes” is selected, the provider must complete the Universal Design Scoresheet
(UDS) and submit it along with the completed RPAA. The UDS form can be found on the DDDS
website:
http://www.dhss.delaware.gov/dhss/ddds/providercontract.html
 LINE 4B: Indicate the number of licensed / certified beds within the residence by using the drop-
down menu to select the letter “P”. This will place a check mark in the appropriate box.
 LINE 4C: Indicate the number of bedrooms intended to be used for sleeping quarters by using
the drop-down menu to select the letter “P”. This will place a check mark in the appropriate box.
 LINE 5A: In the spaces provided, type the first name, last name and date of birth (DOB) for each
individual within the residence who receives DDDS services. If sleeping quarters have not yet
been assigned at the time of RPAA form completion, type “Vacant” under “First Name”. Under
“Last Name”, type the target date that the vacancy is expected to be filled.
 LINE 5B: Indicate whether any individual living in the residence has special programmatic needs
by using the drop-down menu to select the letter “P”. This will place a check mark in the
appropriate box.
Please note that if “Yes” is selected, the provider must complete the Programmatic Features
Assessment (PFA) Form and submit it along with the completed RPAA. The PFA form can be found
on the DDDS website:
http://www.dhss.delaware.gov/dhss/ddds/providercontract.html
 LINE 6: Indicate why the form is being submitted by using the drop-down menu to select the
letter “P”. This will place a check mark in the appropriate box.
 LINE 6A: Indicate the utilities and services provided by the Lessor and included within the lease /
finance amount by using the drop-down menu to select the letter “P”. This will place a check
mark in the appropriate boxes.
 LINE 6B: Indicate the utilities and services provided by the Lessor and NOT included within the
lease / finance amount by using the drop-down menu to select the letter “P”. This will place a
check mark in the appropriate boxes.
 LINE 6C: Type the estimated MONTHLY amount for all utilities NOT included within the lease /
finance amount.
Example: Line 6B has electric, trash and water checked.
Estimated monthly electric is $195.
Estimated monthly trash is $50
Estimated monthly Water is $135
Monthly Amount = $195 + $50 + $135 = $380
 LINE 7: Indicate if the property is owned or leased by using the drop-down menu to select the
letter “P”. This will place a check mark in the appropriate box.
If the property is owned, proceed to Question 7A.
If the property is leased, proceed to Question 7B.
(Note that the provider is only responsible for completing Section 7A or Section 7B).
Please note that if the property is owned, the provider must submit the following supporting
documentation along with the completed RPAA:
1. Copy of the mortgage statement/finance document (if property not paid in full)
2. Property Insurance Certificate
3. Property and/or School Tax Statements (If not waived due to nonprofit status)
 LINE 7Ai: Type the Lessor’s name.
 LINE 7Aii: Type the Lessor’s address.
 LINE 7Aiii: Type the Lessor’s phone number & primary contact at Lessor’s office.
 LINE 7Aiv: Type the effective date and ending date of lease term.
 LINE 7Av: Type the monthly lease amount. If renewing a lease, provide the previous monthly
amount in the space provided.
 LINE 7Avi: Type the amount of monthly renter’s insurance.
 LINE 7Bi: Type the monthly mortgage/finance. This figure may include mortgage principal and
interest. If the property is owned (i.e., not financed), please type $0.00.
 LINE 7Bii: Type the effective date and ending date of the finance period.
 LINE 7Biii: Type the name of the Lender.
 LINE 7Biv: Type the interest rate extended for financing.
 LINE 7Bv: Type the monthly property taxes. If none, please type $0.00.
 LINE 7Bvi: Type the monthly school taxes. If none, please type $0.00.
 LINE 7Bvii: Type the monthly home owner’s insurance.
 LINE 7Bvii: Indicate if the property lender requires reserves for repairs / maintenance by using
the drop-down menu to select the letter “P”. This will place a check mark in the appropriate box.
If “Yes” is selected, please type the amount of monthly reserves required by the property lender.
 LINE 8: Indicate if the property is financed by the Department of Housing and Urban
Development (HUD) by using the drop-down menu to select the letter “P”. This will place a check
mark in the appropriate box.
 LINE 9: Type the fair market value (FMR) of the property according to the most-recent guidelines
published by the Department of Housing and Urban Development (HUD). FMR guidelines are
found on the HUD website:
https://www.huduser.gov/portal/datasets/fmr.html
 LINE 10: Indicate if the lease amount from Line 7A or the mortgage amount from Line 7B is equal
to or less than the HUD FMR amount from Line 10. Use the drop-down menu to select the letter
“P”, which will place a check mark in the appropriate box.
 PROVIDER ATTESTATION STATEMENT: This is the final section of the RPAA to be completed by
the provider. This section must be signed and dated by an authorized agency representative
empowered to enter into a lease or financing agreement for a leased or owned property.
 FOR OBCBS SECTION: (Members of the OBCBS Contracts Unit will complete this section). When
appropriate signatures are obtained, the document will be scanned and emailed to the Provider
for their files.
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