Title III Reporting Forms

View Links, Handbooks, and Resources Here 

Supplemental Handouts

• ITCA-Title-III-Reporting-summary-Tribes
  
• Clients Rights & Responsibility
• Grievance Procedure & Cost Sharing
• DAARS Instructions_Rev 4.25
• HHS Poverty Guidelines for 2021
  
• Authorization for Release of Confidential Information

Home Delivered Meals 

• Short Form Intake Document (SFID)
• HHS Poverty Guidelines for 2021
• SFID Service Matrix DES AZ DAAS
• SFID Overview Tribal Power Point

Congregate Meals

• Congregate Meals Nutritional Assessment
• Short Form Intake Document (SFID)
• CNG Nutritional Assessment Form (Fillable Form) 
  
• Title III Nutritional Assessment_Guide

Caregiver Training

• Caregiver Reg Forms (Caregiver Training)
• Caregiver Assessment Tool (CAT) Fillable Form
  
• Caregiver Assessment Tool (CAT) Form-3-Pages

Caregiver Outreach / Caregiver Information & Referral

• Caregiver Non Reg Forms

EnhanceFitness

• Social Services Report_Non-Reg

A Matter of Balance

• Social_Service_Report_-Non-Reg-FY 2020

Transportation

• Social Services Report_Non-Reg
• Monthly Report Form – Transportation
• Vehicle Inspection Checklist

Socialization & Recreation

• SocRec-Monthly-Reporting-Form_FY2021
• SocRec-Monthly-Reporting-FY21
• SocRec-Monthly-Reporting-Form_FY2021
• SocRec-Summary-Report_FY 2021

Long Term Care / Ombudsman

• Time Sheet for Staff and Volunteers revised 4_25_18
• Monthly Ombudsman Data Collection Form
• Case Complaint Form
• HHS Poverty Guidelines for 2020

Public Benefit Outreach Project Form

• Client Contact fillable form
• Group Outreach and Education Form_PAM
• Media Outreach and Education form