Form DDD-2113A Ddd-Evv Member Contingency / Back-Up Plan for the Independent Provider Program - Arizona

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Form DDD-2113A Ddd-Evv Member Contingency / Back-Up Plan for the Independent Provider Program - Arizona

What Is Form DDD-2113A?

This is a legal form that was released by the Arizona Department of Economic Security - a government authority operating within Arizona. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is Form DDD-2113A?
A: Form DDD-2113A is a Member Contingency/Back-Up Plan for the Independent Provider Program in Arizona.

Q: What is the purpose of Form DDD-2113A?
A: The purpose of Form DDD-2113A is to establish a contingency/back-up plan for the Independent Provider Program in Arizona.

Q: Who is required to complete Form DDD-2113A?
A: Members of the Independent Provider Program in Arizona are required to complete Form DDD-2113A.

Q: What is the Independent Provider Program?
A: The Independent Provider Program is a program in Arizona that allows individuals with disabilities to hire and manage their own support workers.

Q: Why is a contingency/back-up plan necessary?
A: A contingency/back-up plan is necessary to ensure continuity of care and support for individuals with disabilities in case the primary provider is unable to fulfill their duties.

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Form Details:

  • Released on August 1, 2021;
  • The latest edition provided by the Arizona Department of Economic Security;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;

Download a fillable version of Form DDD-2113A by clicking the link below or browse more documents and templates provided by the Arizona Department of Economic Security.

Download Form DDD-2113A Ddd-Evv Member Contingency / Back-Up Plan for the Independent Provider Program - Arizona

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