Ariz. Admin. Code § R6-6-402 - Application for the Division of Developmental Disabilities Services

A. An applicant shall:

2. 1. Complete, sign, and submit an application on the form or by the method provided by the Division;

1. 2. Participate in a face-to-face interview with a designated Department employee, if requested by the Division or the applicant; and

3. Submit information and documents to support the application, as required by the Division.

B. Upon application, the applicant agrees to abide by federal and state statutes and regulations and Department policy.

B. C. The application shall contain, at a minimum:

1. With respect to the person applying:

a. Name, address, and telephone number;

b. Date of birth, place of birth, gender, primary language, and proof of U.S. citizenship;

c. Monthly income;

d. c. Medical insurance coverage;

e. d. Educational history, including educational placements

f. e. Information showing the existence of a developmental disability, including professional assessments and evaluations, as required in A.R.S. § 36-559(A)(2) and Article 3 of this Chapter; and

g. f. A description of any other disabling conditions or special considerations.

h. If under 18 years of age, total number of persons in the household;

i. Identification of any adults who regularly live in the home by name, date of birth, and relationship to the person to receive services;

j. Identification of natural parents, regardless of whether living in the home, by name, social security number, and business and home telephone numbers; and

k. Identification of two adult persons living outside the home who are familiar with the person to receive services, by name, address, relationship to the person to receive services, and business and home telephone numbers; and

2. With respect to the responsible person, if other than the person to whom services would be provided:

a. Name, home address, and telephone number; and

b. Relationship to person to whom services would be provided.

c. D. If guardianship or conservatorship has been established, the applicant shall provide a copy of the court order with the application.

C. The applicant shall provide a description of programs and services requested.

D. The applicant shall provide information regarding prior applications for admissions to Division services or services received.

E. The applicant shall provide documentation of application information as defined in R6-6-405 .

F. E. The Division shall not consider an incomplete application.

1. Within 10 calendar days of receipt of an incomplete application, the Division shall notify the applicant of the information needed to complete the application and request the missing information.

2. If the applicant does not provide the specified information within 15 working days of receipt of notification of deficiencies, or cannot demonstrate a good faith effort to collect the information, the Division shall close the applicant's file and send a letter denying admission.

F. If the applicant does not provide the requested information to the Division by the date specified in the notification under subsection (E), the Division may deny the application and close the file.

G. An applicant whose file has been closed, and who subsequently desires admission, shall submit a new application.

Notes

Ariz. Admin. Code § R6-6-402

Adopted effective February 2, 1989 (Supp. 89-1). Section repealed, new Section adopted effective June 7, 1993, under an exemption from A.R.S. Title 41, Chapter 6 (Supp. 93-2). Amended effective September 30, 1993, under an exemption from A.R.S. Title 41, Chapter 6 (Supp. 93-3). Section expired under A.R.S. § 41-1056(J) at 23 A.A.R. 465, effective January 11, 2017 (Supp. 17-1). Adopted by final rulemaking at 26 A.A.R. 1871, effective 10/20/2020.