Letter to Providers of Agency Companion

December 22, 2020

Administrative Letter 21-06

Dear Agency Companion Provider,

In an effort to improve processes and create efficiency, DDS has made significant changes to forms used in the Home Development process described in OAC 317:40-5-40. The following changes will result in reduced redundancies in the development of a home. They will not affect the quality of information gathered, but will reduce the number of forms and the number of times a caregiver may be asked to answer the same questions. This is effective beginning January 1, 2021.

1. The following forms have been revoked, but still exist in policy OAC 317:40-5-40. The use of these forms may be discontinued per this memo. Policy changes have been submitted which remove these forms as a requirement.

06AC009E Financial Assessment
06AC011E Family Health History
06AC012E Information Sheet
06AC015E Employment Record
06AC017E Insurance Information
06AC016E DDS Reference Information Waiver
06AC019E Child’s Questionnaire
06AC048E Placement Record
06AC049E Orientation Attendance Sheet
06AC050E Orientation Attendance Verification
06AC068E Internal Request for Background Information
06AC074E Service Authorization Budget

2. The following forms have been revised:

04AD003E, Request for Background Check
04FT007E, Request to Release Child Abuse and Neglect Findings
06AC008E SFC/AC Application
06AC069E Review of Policies and Areas of Responsibility
06AC013E Pre-Screening for SFC/AC
06AC018E Self-Study Questionnaire
06AC058E Reference Letter

3. New/Adopted forms:

06AC001E, Foster Parent/Companion Family Reference Letter for Adult Children (replaced 04AF015E)
06AC002E Family Financial Assessment (replaced 06AC009E)
06AC003E Foster Parent/Companion Health History (replaced 06AC011E)

You may contact chris.castleberry@okdhs.org, 405-833-9263, cindy.leishman@okdhs.org, or andrea.chandler@okdhs.org for technical assistance or questions. Please access the latest version of forms at OKDHS.org in the forms library. The direct link is: https://oklahoma.gov/okdhs/searchcenter/okdhsformresults.html.

Sincerely,

Chris Castleberry
Program Manager II
Developmental Disabilities Services,
Oklahoma Human Services

Last Modified on Dec 30, 2020