Form 2068, Application/Redetermination or Monitoring for Community Care Services

Effective Date
09/2017
Document
Document
2068.pdf (260.38 KB)
Document
Document
2068-S.pdf (997.67 KB)

Instructions

Updated: 2/2009

Purpose

  • To serve as a cover letter for applications/redeterminations and monitoring contacts.
  • To notify individuals of an appointment to determine/redetermine eligibility for services.

Procedure

When to Prepare

Send Form 2068 with each application/redetermination form. When needed, also send Form 2068 to inform an applicant or individual of a scheduled appointment.

Number of Copies

Complete an original and one copy.

Transmittal

Send the original to the applicant/individual and retain the copy in the case record.

Form Retention

Retain the case record copy for three years.

Detailed Instructions

Self-explanatory.