Forms In this section of our website, you will find commonly used forms to apply for and manage DD services. If you have questions about the content on this page, please email us at bhddh.askdd@bhddh.ri.gov. Fiscal Resources Billing Manuals FY24 Billing Manual FY23 Billing Manual Rate Tables FY24 Rate Table FY23 Rate Table Tier Packages FY24 Annual Funding Levels (Tier Package) in English and Spanish FY23 Annual Tier Package Purchase Order Purchase Order Templates FY24 Purchase Order Template FY23 Purchase Order Home Health Agency Purchase Order Allocation Forms Request to Change Respite Allocation Self-Direct Reallocation for Transportation Form Request to Change Transportation Allocation Eligibility DDD Eligibility Forms Visit the DDD Eligibility webpage Medicaid Waiver Application Have Medicaid or SSI Application Coversheet Blank Recertification CP-1 Eligibility Assessment Level of Care CP-12 Form Release of Information - Medical (DHS-25-M) Release of Information (DHS-25) Do not already have Medicaid Application Coversheet CP-1 Eligibility Assessment Level of Care CP-12 Form DHS-2 Application Release of Information - Medical (DHS-25-M) Release of Information (DHS-25) Individualized Planning Tools Individualized Planning Tools DD ISP Submission Requirements ISP Addendum/Amendment Form: Please submit this form with any changes to a current ISP or PO. Emergency Data Form: Be sure to send any personal information through an encrypted or secure email NCAPPS Promising Practices for Person-Centered Plans: read this booklet to learn more about what a good person-centered plan looks like Individual Support Plan Samples Individual Support Plan Sample #1 in Word and PDF Individual Support Plan Sample #2 in Word and PDF Individual Support Plan Sample #3 in Spanish Individual Support Plan Attachment Form in Word and PDF Employment Employment Forms Employment and Earnings Reporting Form Targeted Employment Funding Request Form Targeted Employment Plan Form Variance Forms Variance Submission and Review instructions Variance for Integrated Day Services Only Variance to Work in a Segregated Employment Setting Service Request Supplemental Funding Forms S106 Form for emergent need changes S109 Form for nonemergent need changes Quick Extension Form S109 and S106 HM fillable form L9 Conversion Worksheet FY23 new rates in Excel or PDF IEP Request Notification of BHDDH of IEP/CDP Meeting Medical Forms Consultation/Referral Form Request for Petition for Instructions Note: Adobe Reader To fill-in a PDF application on your computer, you will need Adobe Reader software installed on your computer. There is no cost to install Adobe Reader and is available here. You may also print the application, fill it out and mail to the BHDDH, Division of Developmental Disabilities, 6 Harrington Hall, Cranston, RI 02920.