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This version of the form is not currently in use and is provided for reference only. Download this version of
Form DSS-EA-265
for the current year.
Form DSS-EA-265 Request for Long-Term Care or Home Community Based Services Waiver Assistance - South Dakota
What Is Form DSS-EA-265?
This is a legal form that was released by the South Dakota Department of Social Services - a government authority operating within South Dakota. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form DSS-EA-265?
A: Form DSS-EA-265 is a request for Long-Term Care or Home Community Based Services Waiver Assistance in South Dakota.
Q: Who can use Form DSS-EA-265?
A: Any individual who is in need of long-term care or home community based services in South Dakota can use this form.
Q: What is Long-Term Care or Home Community Based Services Waiver Assistance?
A: Long-Term Care or Home Community Based Services Waiver Assistance is a program in South Dakota that helps individuals receive necessary care and services in their home or community instead of a nursing home or institution.
Q: How do I fill out Form DSS-EA-265?
A: You need to provide your personal information, medical history, and details about the care and services you require in the form.
Q: What documents are required to be submitted with Form DSS-EA-265?
A: You may need to submit documents such as medical records, income verification, and proof of residency with the form.
Q: Are there any fees associated with Form DSS-EA-265?
A: There are no fees associated with submitting this form.
Q: What if I need assistance in filling out Form DSS-EA-265?
A: You can contact the South Dakota Department of Social Services for assistance in filling out the form.
Form Details:
- Released on August 1, 2016;
- The latest edition provided by the South Dakota Department of Social Services;
- Easy to use and ready to print;
- Available in Spanish;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form DSS-EA-265 by clicking the link below or browse more documents and templates provided by the South Dakota Department of Social Services.
Download Form DSS-EA-265 Request for Long-Term Care or Home Community Based Services Waiver Assistance - South Dakota
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