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Dodd Home and Community-Based Services (Hcbs) Disenrollment and Withdrawal of Waiver Application Consent Form - Ohio
Dodd Home and Community-Based Services (Hcbs) Disenrollment and Withdrawal of Waiver Application Consent Form is a legal document that was released by the Ohio Department of Developmental Disabilities - a government authority operating within Ohio.
FAQ
Q: What is the Dodd Home and Community-Based Services (HCBS) Disenrollment and Withdrawal of Waiver Application Consent Form in Ohio?A: The Dodd HCBS Disenrollment and Withdrawal of Waiver Application Consent Form in Ohio is a document that allows individuals to voluntarily withdraw from or disenroll from the Home and Community-Based Services (HCBS) waiver program.
Q: Who can use the Dodd HCBS Disenrollment and Withdrawal of Waiver Application Consent Form?A: This form can be used by individuals who are currently enrolled in or have applied for the HCBS waiver program in Ohio and wish to withdraw their application or disenroll from the program.
Q: What is the purpose of the Dodd HCBS Disenrollment and Withdrawal of Waiver Application Consent Form?A: The purpose of this form is to obtain the consent of the individual to withdraw from or disenroll from the HCBS waiver program and to document their decision.
Q: How can I get a copy of the Dodd HCBS Disenrollment and Withdrawal of Waiver Application Consent Form?A: You can obtain a copy of this form by contacting the Ohio Department of Medicaid or the agency that administers the HCBS waiver program in your area.
Q: Are there any deadlines or requirements for submitting the Dodd HCBS Disenrollment and Withdrawal of Waiver Application Consent Form?A: The specific deadlines and requirements for submitting this form may vary depending on the policies and procedures of the HCBS waiver program in Ohio. It is recommended to contact the program administrator for more information.
Form Details:
- Released on March 1, 2015;
- The latest edition currently provided by the Ohio Department of Developmental Disabilities;
- Ready to use and print;
- Easy to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a printable version of the form by clicking the link below or browse more documents and templates provided by the Ohio Department of Developmental Disabilities.
