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Application for Exemption or for Re-Evaluation – Contribution by users under the care of intermediate resources
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This form is used to request a change in the financial contribution amount required for an adult being accommodated via an intermediate resource. For instructions for completing the form, use the Guide to the Application for exemption.

Form 4475
Tariff for insured devices which compensate for a motor deficiency and related services, January 1, 2021
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This list was published on December 16, 2020.
Notice – Tariff for insured devices which compensate for a motor deficiency and related services, January 1, 2021
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Tariff for insured devices which compensate for a motor deficiency and related services, December 12, 2016
/en/media/12241
This list was published in December 12, 2016.
Notice – Tariff for insured devices which compensate for a motor deficiency and related services, July 1, 2016
/en/media/12246
This list was published on June 13, 2016.
Tariff for insured devices which compensate for a motor deficiency and related services, February 16, 2016
/en/media/12251
This list was published on February 16, 2016.
Notice – Tariff for insured devices which compensate for a motor deficiency and related services, December 12, 2016
/en/media/12256
Notice – Tariff for insured devices which compensate for a motor deficiency and related services, July 1, 2016
/en/media/12261
Notice – Tariff for insured devices which compensate for a motor deficiency and related services, February 16, 2016
/en/media/12266
Tariff for insured devices which compensate for a motor deficiency and related services 1, March 1, 2017
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This list was published on January 23, 2017.