| DS 1820 |
Notice of Action (NOA) |
Consumer/Families |
| DS 1820 (Spanish) |
Avisio de Acción (NOA) |
Consumer/Families |
| DS 223 |
Family Home Agency Program (FHA) Criminal Background Action Form |
FHA |
| DS 224 |
Confidential Employment and Personal Reference Survey |
FHA |
| DS 5516 |
Restraint Reporting Form |
Vendor/Provider
|
| DS 6014 |
Criminal Record Statement |
Vendor/Provider |
| DS 229 |
Self-Determination Program (SDP) Criminal Background Action Form |
SDP |
| DS 5305-8-F |
Data Exchange Security Questionnaire Form |
Data Privacy |
| DS 6011 (Vietnamese) |
Annual Family Program Fee Payment Form, Second Notice (Vietnamese) |
Consumer/Families |
| DS 6011 (Tagalog) |
Annual Family Program Fee Payment Form, Second Notice (Tagalog) |
Consumer/Families |
| DS 6011 (Spanish) |
Annual Family Program Fee Payment Form, Second Notice (Spanish) |
Consumer/Families |
| DS 6011 (Russian) |
Annual Family Program Fee Payment Form, Second Notice (Russian) |
Consumer/Families |
| DS 6011 (Chinese Traditional) |
Annual Family Program Fee Payment Form, Second Notice (Chinese Traditional) |
Consumer/Families |
| DS 6011 |
Annual Family Program Fee Payment Form, Second Notice |
Consumer/Families |
| DS P304 (Spanish) |
Rights of Individuals with Developmental Disabilities (Spanish) |
Complaint |
| DS P304 |
Rights of Individuals with Developmental Disabilities |
Complaint |
| DS 6028 |
Community Crisis Home – Rate Development Individual Costs Associated with Transition |
Vendor/Provider |
| DS 6024 |
Rate Development – Individual Costs Associated with Residency |
Vendor/Provider |
| DS 6023 |
Rate Development-Facility Costs |
Vendor/Provider |
| DS 6022 (Simplified Chinese) |
Language Access Complaint Form (Simplified Chinese) |
General |
| DS 6022 (Traditional Chinese) |
Language Access Complaint Form (Traditional Chinese) |
General |
| DS 6022 (Korean) |
Language Access Complaint Form (Korean) |
General |
| DS 6022 (Tagalog) |
Language Access Complaint Form (Tagalog) |
General |
| DS 6022 (Vietnamese) |
Language Access Complaint Form (Vietnamese) |
General |
| DS 6022 (Spanish) |
Language Access Complaint Form (Spanish) |
General |
| DS 6022 |
Language Access Complaint Form |
General |
| DS 6016 |
Conflict of Interest Reporting Statement |
General |
| DS 6015 |
Criminal History Statement |
Vendor/Provider |
| DS 5862 (Vietnamese) |
Parental Verification for Receipt of Behavioral Services (Vietnamese) |
Consumer/Families |
| DS 5862 (Tagalog) |
Parental Verification for Receipt of Behavioral Services (Tagalog) |
Consumer/Families |
| DS 5862 (Spanish) |
Parental Verification for Receipt of Behavioral Services (Spanish) |
Consumer/Families |
| DS 5862 (Russian) |
Parental Verification for Receipt of Behavioral Services (Russian) |
Consumer/Families |
| DS 5862 (Chinese Traditional) |
Parental Verification for Receipt of Behavioral Services (Chinese Traditional) |
Consumer/Families |
| DS 5862 |
Parental Verification for Receipt of Behavioral Services |
Consumer/Families |
| DS 6017 |
Authorization for Release of Information, Photographs or Recordings for Communication or Media-Relation Purposes |
Consumer/Families |
| DS 6017 (Spanish) |
Authorization for Release of Information, Photographs or Recordings for Communication or Media-Relation Purposes (Spanish) |
Consumer/Families |
| DS 6017 (Hmong) |
Authorization for Release of Information, Photographs or Recordings for Communication or Media-Relation Purposes (Hmong) |
Consumer/Families |
| DS 6017 (Arabic) |
Authorization for Release of Information, Photographs or Recordings for Communication or Media-Relation Purposes (Arabic) |
Consumer/Families |
| DS 6017 (Armenian) |
Authorization for Release of Information, Photographs or Recordings for Communication or Media-Relation Purposes (Armenian) |
Consumer/Families |
| DS 6017 (Simplified Chinese) |
Authorization for Release of Information, Photographs or Recordings for Communication or Media-Relation Purposes (Simplified Chinese) |
Consumer/Families |
| DS 6017 (Traditional Chinese) |
Authorization for Release of Information, Photographs or Recordings for Communication or Media-Relation Purposes (Traditional Chinese) |
Consumer/Families |
| DS 6017 (Farsi) |
Authorization for Release of Information, Photographs or Recordings for Communication or Media-Relation Purposes (Farsi) |
Consumer/Families |
| DS 6017 (Korean) |
Authorization for Release of Information, Photographs or Recordings for Communication or Media-Relation Purposes (Korean) |
Consumer/Families |
| DS 6017 (Russian) |
Authorization for Release of Information, Photographs or Recordings for Communication or Media-Relation Purposes (Russian) |
Consumer/Families |
| DS 6017 (Tagalog) |
Authorization for Release of Information, Photographs or Recordings for Communication or Media-Relation Purposes (Tagalog) |
Consumer/Families |
| DS 6017 (Vietnamese) |
Authorization for Release of Information, Photographs or Recordings for Communication or Media-Relation Purposes (Vietnamese) |
Consumer/Families |
| DS 3770 |
Medicaid Waiver Eligibility Record |
Regional Center |
| DS 2201 (Spanish) |
Home and Community Based Services Waiver Consumer Standardized Annual Review (Spanish) |
Vendor/Provider |
| DS 2201 |
Home and Community Based Services Waiver Consumer Standardized Annual Review |
Vendor/Provider |
| DS 2200 |
Medicaid Waiver Consumer Choice of Services/Living Arrangement Statement |
General |
| DS 2007 (Spanish) |
Citizen Comments and Complaints (Spanish) |
General |
| DS 2007 |
Citizen Comments and Complaints |
Vendor/Provider |
| DS 1971 |
WAP – WAP/Work Activity Program Consumer Monthly Report |
Vendor/Provider |
| DS 1969 |
Vocational Services Exit Program |
Vendor/Provider |
| DS 1968 |
Vocational Rehabilitation Referral |
Vendor/Provider |
| DS 1967 |
Request for Rate Adjustment – Staff Change |
Vendor/Provider |
| DS 1966 |
Request for Rate Adjustment – Occupancy Change |
Vendor/Provider |
| DS 1964 Large |
1-900 lines – April 2022 |
Vendor/Provider |
| DS 1964 Large |
Supported Employment Group Billing and Attendance Form (Rate $39.57) |
Vendor/Provider |
| DS 1963 |
Request for Approval of SEP Groups Changes |
Vendor/Provider |
| DS 1962 |
Supplemental Narrative Summary Guidance Template |
Vendor/Provider |
| DS 1962 |
Request for new SEP Groups |
Vendor/Provider |
| DS 1961 |
WAP – WAP/Individual Habilitation Services Plan |
Vendor/Provider |
| DS 1950 |
Habilitation Services Cost Statement Forms (w/out Formulas) |
Vendor/Provider |
| DS 1950 |
Habilitation Services Cost Statement Forms (w/Formulas) |
Vendor/Provider |
| DS 1897B |
in-Home Respite Cost Statement |
Vendor/Provider |
| DS 1897 |
Community-Based Day Program Cost Statement |
Vendor/Provider |
| DS 1891 (Spanish) |
Applicant/Vendor Disclosure Statement (Spanish) |
Vendor/Provider |
| DS 1891 |
Applicant/Vendor Disclosure Statement |
Vendor/Provider |
| DS 1890 (Spanish) |
Vendor Application Form (Spanish) |
Vendor/Provider |
| DS 1890 |
Vendor Application Form |
Vendor/Provider |
| DS 1853 |
Training Program for ICF/DD-N Attendant |
Vendor/Provider |
| DS 1852 |
Health Facility Program Plan Application |
Vendor/Provider |
| DS 1851 |
Specialized Procedures Request Cover Sheet |
Vendor/Provider |
| DS 1827 (Spanish) |
Early Start Compliant Investigation Request (Spanish) |
Early Start |
| DS 1827 |
Early Start Compliant Investigation Request |
Early Start |
| DS 1811 (Spanish) |
Respite Services Billing Form (Spanish) |
Vendor |
| DS 1811 |
Respite Services Billing Form |
Vendor |
| DS 1808 (Traditional Chinese) |
Mediation Conference Request (Traditional Chinese) |
Early Start |
| DS 1808 (Simplified Chinese) |
Mediation Conference Request (Simplified Chinese) |
Early Start |
| DS 1808 (Tagalog) |
Mediation Conference Request (Tagalog) |
Early Start |
| DS 1808 (Korean) |
Mediation Conference Request (Korean) |
Early Start |
| DS 1808 (Vietnamese) |
Mediation Conference Request (Vietnamese) |
Early Start |
| DS 1808 (Spanish) |
Mediation Conference Request (Spanish) |
Early Start |
| DS 1808 |
Mediation Conference Request |
Early Start |
| DS 1802 (Traditional Chinese) |
Due Process Hearing Request (Traditional Chinese) |
Early Start |
| DS 1802 (Simplified Chinese) |
Due Process Hearing Request (Simplified Chinese) |
Early Start |
| DS 1802 (Tagalog) |
Due Process Hearing Request (Tagalog) |
Early Start |
| DS 1802 (Korean) |
Due Process Hearing Request (Korean) |
Early Start |
| DS 1802 (Vietnamese) |
Due Process Hearing Request (Vietnamese) |
Early Start |
| DS 1802 (Spanish) |
Due Process Hearing Request (Spanish) |
Early Start |
| DS 1802 |
Due Process Hearing Request |
Early Start |
| DS 1235A (Spanish) |
Family Financial Statement (Spanish) |
Parental Fee |
| DS 1235A |
Family Financial Statement |
Parental Fee |
| DS 1214 (Spanish) |
Parental Fee Program Home Leave Credits (Spanish) |
Parental Fee |
| DS 1214 |
Parental Fee Program Home Leave Credits |
Parental Fee |
| DS 306 |
Denial of Rights Report |
Complaint |
| DS 255 (Spanish) |
Welfare and Institution Code Section 4731 Compliant Form Investigation Request (Spanish) |
Complaint |
| DS 255 |
Welfare and Institution Code Section 4731 Compliant Form Investigation Request |
Complaint |
| DS 228 |
Applicant Information Release |
OPS |
| DS 202 (Korean) |
Request for OPS Investigative Report (Korean) |
OPS |
| DS 202 (Simplified Chinese) |
Request for OPS Investigative Report (Simplified Chinese) |
OPS |
| DS 202 (Traditional Chinese) |
Request for OPS Investigative Report (Traditional Chinese) |
OPS |
| DS 202 (Spanish) |
Request for OPS Investigative Report (Spanish) |
OPS |
| DS 202 (Tagalog) |
Request for OPS Investigative Report (Tagalog) |
OPS |
| DS 202 (Vietnamese) |
Request for OPS Investigative Report (Vietnamese) |
OPS |
| DS 202 |
Request for OPS Investigative Report |
OPS |
| DS 43 (Spanish) |
Request to Inspect Public Records (Spanish) |
PRA |
| DS 43 |
Request to Inspect Public Records |
PRA |
| DS 2 |
Transportation Cost Statement |
Services |
