Forms On this page you will find commonly used forms to apply for and manage DD services. If you have questions about what is on this page, please email us at bhddh.askdd@bhddh.ri.gov. Fiscal Resources Billing Manuals FY25 Billing Manual (PDF) FY25 Billing Communication and FAQs to Providers (PDF) FY24 Billing Manual (PDF) FY23 Billing Manual (PDF) Rate Tables FY25 Rate Table (PDF) FY24 Rate Table (PDF) Tier Packages FY25 Annual Funding Levels (Tier Package) in English (PDF) and Spanish (PDF) FY24 Annual Funding Levels (Tier Package) in English (PDF) and Spanish (PDF) Purchase Order Purchase Order Templates FY24 Purchase Order Template (xlsx) FY23 Purchase Order (xlsx) Home Health Agency Purchase Order (xlsx) Allocation Forms Request to Change Respite Allocation (PDF) Self-Direct Reallocation for Transportation Form (xlsx) Request to Change Transportation Allocation (xlsx) Eligibility DDD Eligibility Forms Visit the DDD Eligibility webpage Medicaid Waiver Application Have Medicaid or SSI Application Coversheet (PDF) Blank Recertification (PDF) CP-1 Eligibility Assessment Level of Care (PDF) CP-12 Form (Word) Release of Information - Medical (DHS-25-M) (PDF) Release of Information (DHS-25) (PDF) Do not already have Medicaid Application Coversheet (PDF) CP-1 Eligibility Assessment Level of Care (PDF) CP-12 Form (Word) DHS-2 Application (PDF) Release of Information - Medical (DHS-25-M) (PDF) Release of Information (DHS-25) (PDF) Individualized Planning Tools ISP Template CFCM Person-Centered Plan Form Template 2024 (PDF) Individualized Planning Tools DD ISP Submission Requirements (PDF) ISP Addendum/Amendment Form (PDF): Please submit this form with any changes to a current ISP or PO. Emergency Data Form (PDF): Be sure to send any personal information through an encrypted or secure email NCAPPS Promising Practices for Person-Centered Plans (PDF): read this booklet to learn more about what a good person-centered plan looks like Employment Employment Forms Employment and Earnings Reporting Form (PDF) NEW online reporting form Targeted Employment Funding Request Form (web form) Targeted Employment Plan Form (PDF) Variance Forms Variance Submission and Review instructions (PDF) Variance for Integrated Day Services Only (PDF) Variance to Work in a Segregated Employment Setting (PDF) Service Request Supplemental Funding Forms S106 Form for emergent need changes (PDF) S109 Form for nonemergent need changes (PDF) Quick Extension Form S109 and S106 HM fillable form (PDF) L9 Conversion Worksheet FY23 new rates in Excel or worksheet in PDF Medical Forms Consultation/Referral Form (PDF) Request for Petition for Instructions (PDF) Conflict-Free Case Management (CFCM) CFCM 1-Month Monitoring Form 2024 (PDF) CFCM 6-Month Monitoring Form 2024 (PDF) CFCM/IF Creating A Personal Profile (Word) CFCM/IF Roles and Responsibilities (PDF) CFCM/IF Plan Review Rubric (PDF) CFCM/IF Life Domains - Part 1 (Word) CFCM/IF Annual Life Domains Form (PDF) CFCM/IF Intro letter (Word) CFCM/IF Meeting Confirmation Letter DD (Word) CFCM/IF Meeting Confirmation Letter with Other Invitees (Word) CFCM/IF WellSky Risks and Objectives Reference for DD Case Managers (Excel) 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.