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Staff Contact

North Carolina Division of Aging and Adult Services

Consumer Directed Service (Home Care Independence)


Provider Agency Forms and Documents

Memorandum of Agreement Word PDF
DAAS Client Registration Form Word PDF
Participant Self-Assessment Form Word PDF
Service Assessment/Reassessment Form Word PDF
Appointment of Representative For Participant   PDF
Participant Enrollment Form

Word PDF
CDS Plan of Care/Budget Word PDF
Back Up Plan for CDS Word PDF
Participant Bill Of Rights Word PDF
Employment Application and Criminal Record Check Consent Form Word PDF
Participant Referral Form for FMS Word PDF
Change Order Form for FMS

Word PDF
CDS Criminal Background Check Policy   PDF

FMS Forms and Documents

FMS Agreement Word PDF
Employment Agreement   PDF
Personal Assistant Bill of Rights Word PDF
Self Determination Employee Time Card   PDF
Self Determination Timesheet Instructions   PDF
Payroll Schedule   PDF
Fax Coversheet for Self-Determination Clients  

Letter of Inquiry to Personal Assistants Who May Want Extra Work With Other Recipients   PDF


Last updated March 7, 2013


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