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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 DDD-2113A
for the current year.
Form DDD-2113A Ddd-Evv Member Contingency / Back-Up Plan for the Independent Provider Program - Arizona
What Is Form DDD-2113A?
This is a legal form that was released by the Arizona Department of Economic Security - a government authority operating within Arizona. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form DDD-2113A?
A: Form DDD-2113A is a Member Contingency/Back-Up Plan for the Independent Provider Program in Arizona.
Q: What is the purpose of Form DDD-2113A?
A: The purpose of Form DDD-2113A is to establish a contingency/back-up plan for the Independent Provider Program in Arizona.
Q: Who is required to complete Form DDD-2113A?
A: Members of the Independent Provider Program in Arizona are required to complete Form DDD-2113A.
Q: What is the Independent Provider Program?
A: The Independent Provider Program is a program in Arizona that allows individuals with disabilities to hire and manage their own support workers.
Q: Why is a contingency/back-up plan necessary?
A: A contingency/back-up plan is necessary to ensure continuity of care and support for individuals with disabilities in case the primary provider is unable to fulfill their duties.
Form Details:
- Released on August 1, 2021;
- The latest edition provided by the Arizona Department of Economic Security;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form DDD-2113A by clicking the link below or browse more documents and templates provided by the Arizona Department of Economic Security.
Download Form DDD-2113A Ddd-Evv Member Contingency / Back-Up Plan for the Independent Provider Program - Arizona
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