A. Each year, prior to July 1, the Division
shall send a financial information form to each responsible party.
B. The responsible party shall return the
financial information form to the Division within 30 days of the date of the
The responsible party
shall provide the following information on the financial information form:
1. Client name;
2. Parent or responsible party
3. Parent or responsible
4. Declaration of
income from the prior year federal tax return;
5. Declaration of the assets of the client's
estate, including any amount held in trust or in an annuity for the benefit of
the client; and
6. Date and
signature of the individual filling out the form.
D. The responsible party shall provide
documentation that fully discloses the assets of the client's estate and a copy
of the prior year federal tax return.
E. If the responsible party does not return
the financial information form, the Division shall charge 100% of the cost of
care. If a change occurs in financial circumstances or family size during any
year, the responsible party shall contact the Division to amend the financial
F. The Division shall
determine the cost of care portion based on the cost of care and the financial
information submitted by the responsible party.
G. Along with the monthly billing, the
Division shall provide the responsible party with the information used to
determine the cost of care for the client.
H. If the Division does not receive the
required cost of care portion for two consecutive months, the Office of
Accounts Receivable and Collections shall send a delinquent notice to the
responsible party. If the responsible party fails to make the overdue payment
within 30 days after the date of the delinquent notice, the Office of Accounts
Receivable and Collections may take further action to collect, including
requesting a change in the representative payee for benefits or referring the
case to the Office of the Attorney General.
I. The Division reserves the right to
terminate services to a client for nonpayment.