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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 The following forms have been revoked, but still exist in policy OAC 317:40-5-40.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, 405-833-9263,, or for technical assistance or questions. Please access the latest version of forms at in the forms library. The direct link is:


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

Last Modified on Dec 30, 2020
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