B. Insurance, Resources and Funding Information Sheet
The Insurance, Resources and Funding Information Sheet (refer to Appendix C - forms C.3 and C.14) is completed by the SC at the time of development of the Initial and Revised Service Plan, and whenever changes in the information occur. Information regarding the applicant/participant's current insurance, income and resources is obtained from the applicant/participant and verified by the SC. In addition, newly identified income and funding sources are determined.
This form is provided to the RRDS for review by the SC with the submission of the ISP and RSP packet. To maintain the financial privacy of the individual, the form is not distributed to waiver service providers as part of the participant's Service Plan. However, the form must be maintained in the applicant/participant's record by the SC. Information needed to provide specific services to the participant are obtained by the individual waiver service provider through direct request to the SC.