Form 2303, Notice of Spend Down (IHFSP)
Effective Date: 8/2011
To inform the individual who is receiving services that acceptable receipts must be received to substantiate purchases made with In-Home and Family Support Program (IHFSP) funds.
When to Prepare
Complete when the individual who is receiving services is placed on spend down at either the six-month review or recertification.
Number of Copies
One copy and one original.
The original is filed in the case record. A copy is provided to the individual or his/her personal representative.
Retain in the case record for three years after the case is denied or closed.
Effective Date of Spend Down — Enter the first day after the six-month period that is being reconciled.
Amount Due in Subsidy Receipts or Repayment — Enter the amount of subsidy funds that have been placed in spend down.
Amount Due in Capital Expenditure Receipts or Repayment — Enter the amount of capital expenditure funds that have been placed in spend down.
Date Range of Acceptable Receipts — Enter the first day of the period being reconciled in the first blank and the last day of spend down in the second blank.
Due Date of Receipts or Repayment — Enter the date 60 days after the effective date of the spend down period.
The following receipts were submitted but are not acceptable for the stated reason — List the receipts submitted that did not meet IHFSP receipt requirements. Next to each receipt, note the reason the receipt did not meet requirements.