This is a simplified disability verification form for DBHDD providers to use with their application to HCV via DCA. It does not require a clinical approval and does not include diagnosis information, so a standard case manager role is allowed to complete it and sign. It is just a confirmation that the individual has already been verified as having an SPMI diagnosis.
This disability verification is only for use with the HCV application and cannot be used for DBHDD processes. It will help the household receive some additional financial allowance from HCV but is not required for ultimate approval.