Form LCR-1064A Statement of Understanding - Application for Hcbs Certification - Arizona

Form LCR-1064A Statement of Understanding - Application for Hcbs Certification - Arizona

What Is Form LCR-1064A?

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 the LCR-1064A Statement of Understanding?
A: The LCR-1064A Statement of Understanding is a form used for the Application for HCBS Certification in Arizona.

Q: What is HCBS Certification?
A: HCBS Certification stands for Home and Community Based Services Certification, which is a program in Arizona that provides support services to individuals who want to receive care in their own homes or community rather than in a nursing facility.

Q: Who needs to complete the LCR-1064A form?
A: Anyone applying for HCBS Certification in Arizona needs to complete the LCR-1064A form.

Q: What information is required on the LCR-1064A form?
A: The LCR-1064A form requires applicants to provide their personal information, contact details, medical history, and information about the type of HCBS services they are seeking.

Q: Is there a fee to submit the LCR-1064A form?
A: No, there is no fee to submit the LCR-1064A form.

Q: How long does it take to process the LCR-1064A form?
A: The processing time for the LCR-1064A form may vary, but it typically takes several weeks.

Q: What happens after I submit the LCR-1064A form?
A: After you submit the LCR-1064A form, the Arizona Department of Health Services will review your application and determine if you meet the criteria for HCBS Certification.

Q: Can I appeal if my LCR-1064A application is denied?
A: Yes, if your LCR-1064A application is denied, you have the right to appeal the decision.

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Form Details:

  • Released on March 1, 2023;
  • 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 LCR-1064A by clicking the link below or browse more documents and templates provided by the Arizona Department of Economic Security.

Download Form LCR-1064A Statement of Understanding - Application for Hcbs Certification - Arizona

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