LIGAS

[Guest guest]

Besides making sure that the PUNS is updated to reflect the desire for community

residential supports, it would be wise to also have completed the form to which

Grace refers, , " Request for Community Based Services or Placement in a Community

Based Setting "

Here it is for cut and paste or you can request the form your PAS Agency. I

believe it is probably a good idea to return the form to both your PAS Agency

and to DHS/DDD.

Ellen

REQUEST FOR COMMUNITY-BASED SERVICES OR PLACEMENT IN A COMMUNITY-BASED SETTING

Illinois Department of Human Services

Division of Developmental Disabilities

c/o Mr. Brent Stratton

Office of Illinois Attorney General

100 W. Randolph St., 12th Floor

Chicago, IL 60601

This request is on behalf of _________________________________________, an adult

with a developmental disability, who currently lives:

_____ at home OR at __________________________________________________________

(an Intermediate Care Facility for the Developmentally Disabled).

This is a request for Community-Based Services or placement in a Community-Based

Setting under the Illinois Home and Community-Based Services Waiver for Adults

with Developmental Disabilities.

I understand that, by completing this form, I am NOT getting myself/my family

member on a waiting list for services or placement.

I understand that, in order to be placed on a waiting list, I need to enroll

myself/my family member on PUNS.

I understand that I can get more information about PUNS by calling

1-888-DD-PLANS (or 1-866-376-8446 (TTY)) or by going to

http://www.dd.illinois.gov/SignUp.cfm.

I understand that this request is NOT a request for a determination of

eligibility for services or placement. Eligibility determinations are completed

upon selection from PUNS.

Signature: ________________________________________________

Printed Name: ________________________________________________

Address: ________________________________________________

________________________________________________

Phone: ________________________________________________

Date: ________________________________________________

Relationship to person requesting services: ___ Self ___ Guardian

___ Family member ___ Other

Ellen Garber Bronfeld

egskb@...

[Guest guest]

Thanks Ellen,

I remember awhile back getting this form in the mail with the Ligas consent

decree, at first not understanding and then you posted an explanation on

IPADDUnite.

My question is, when you update your PUNS annually with your PAS agent, should

you fill out this form again?

Curiously, this is the first year I have received a reminder from DHS to update

PUNS, usually just relied on my PAS agent (PACT) periodic home visits to to do

it.

Thais

[Guest guest]

I have been told that one only needs to fill out one form, Thais, but it can't

hurt to do it again, in my opinion, when you are updating the PUNS.

Ellen

Ellen Garber Bronfeld

egskb@...