Forms

Budget

Capital Equipment Request (Excel)

Provider rate setting PowerPoint presentations

Home Delivered Meals Budget Workbook
Home Delivered Meals Waiver (3.5MB)
National Aging Program Information System (NAPIS)
Nutrition Services Incentive Program (NSIP)

Quarterly performance reporting

Note: To prevent broken links, all QPR documents must be downloaded from the shared folder on the area agencies on aging (AAA) secure FTP site.

Key Performance Measure Target Revision (MS Word)
Instructions for Key Performance Measure Target Revision (PDF)
QPR User Manual (PDF) [1.2 MB]

Reimbursement

Note: AAA Reimbursement forms can be downloaded from the shared folder on the AAA secure FTP site or requested from the Texas Department of Aging and Disability Services AAA help desk.

Standardized forms for AAAs and providers

Note: Forms are in English unless otherwise specified.

Caregiver Assessment — Instructions and Form — English (MS Word)
Caregiver Assessment — Instructions and Form — English (PDF)
Caregiver Assessment — Instructions and Form — Spanish (MS Word)
Caregiver Assessment — Instructions and Form — Spanish (PDF)
Caregiver Intake (English and Spanish) [PDF]
Caregiver Intake (English and Spanish) [MS Word]
Caregiver Intake (PDF)
Caregiver Intake (MS Word)
Client Information Release (English and Spanish) [PDF]
Client Information Release (English and Spanish) [MS Word]
Client Intake (English and Spanish) [PDF]
Client Intake (English and Spanish) [MS Word]
Client Intake (PDF)
Client Intake (MS Word)
Client Rights and Responsibilities (PDF)
Client Rights and Responsibilities (MS Word)
Client Rights and Responsibilities (Spanish) [PDF]
Client Rights and Responsibilities (Spanish) [MS Word]
Consumer Needs Evaluation Instructions and form (MS Word)
Consumer Needs Evaluation Instructions and form (PDF)
Nutritional Risk Assessment (English and Spanish) [PDF]
Nutritional Risk Assessment (English and Spanish) [MS Word]
Nutritional Risk Assessment Handout (PDF)
Nutritional Risk Assessment Handout (MS Word)
Vendor Agreement (PDF)
Vendor Agreement (MS Word)
Waiver - Congregate Meals Program Form (MS Word)
Waiver - Congregate Meals Program Instructions (PDF)
Waiver - Home Delivered Meals Program
Waiver - Activity other than Nutrition (MS Word)

Voucher program procedures and fill-in forms for homemaker and respite care services

Homemaker Services Guide for Voucher Program Participants and Providers (MS Word)
Homemaker Services Voucher Program — General Guidelines and Procedures (PDF)
Homemaker Services Voucher and Instructions (MS Word)
Homemaker Services Voucher Program Application (MS Word)
Homemaker Services Voucher Program Task Sheet (MS Word)
Homemaker Services Voucher Program Provider Registry Application (MS Word)
Respite Guide for Caregivers and Providers
Respite Voucher Program – General Guidelines and Procedures (PDF)
Respite Voucher and Instructions (MS Word)
Respite Care Program Application (MS Word)
Respite Provider Registry Application (MS Word)

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Updated: April 23, 2013