Form 2118, Community Care Interest List -- Confirmation of Continued Interest
Effective Date: 9/2004
Form 2118 must be sent to an individual on a community care interest list to inform him that community care staff have been unable to contact him regarding continued interest in a community care program(s).
Form 2118 informs the individual that:
- if he fails to contact staff within 30 days from the date of the letter, his name will be removed from the interest list for that service.
- once his name is deleted from the list and he later decides that he would like to receive services from the program, his name will be placed at the bottom of the list.
When to Prepare
If a worker has knowledge that the individual wishes to remain on the interest list, despite the lack of response to our notice, the worker may decide to retain the individual on the list. See Item 1400 (CM-IHFSP Handbook) or Item 2650 (CM-CCAD Handbook) for more details.
If no response is received and the worker has no reason for retaining the individual on the list, the individual should be removed from the CCIL2 database. Use "COULD NOT LOCATE" as the denial reason.
The caseworker prepares an original to be sent to the client and a copy to be kept in regional files.
Date — The caseworker enters the date the form is completed.
Caseworker — Enter the name of the caseworker.
Office Address and Telephone No. — Self-explanatory. Information should be typed or printed legibly.
Individual's Name and Address — Self-explanatory. Information should be typed or printed legibly.
Programs — Enter the name of the program or programs for which the individual has been waiting.