Form 2060 Mc PDF Details

Form 2060 Mc is used by individuals and businesses to report their income and make tax payments. This form can be filed either electronically or through the mail. The IRS has detailed instructions on how to complete this form, so it's important to read them carefully before starting. There are a number of different ways to file Form 2060 Mc, so choose the option that best suits your needs. You may also want to seek out assistance from a tax professional if you have any questions about filing this form.

QuestionAnswer
Form NameForm 2060 Mc
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesCDS, Interdisciplinary, 2060-MC, h2060

Form Preview Example

Texas Department of Aging

Form 2060-MC

and Disability Services

August 2011-E

1915(c) STAR+PLUS Waiver

Addendum to Form 2060

I. Identifying Information

1. Applicant/Member Name

2. Medicaid No.

3. UPDATE 1 – Date Completed

4. UPDATE 1 – ISP Date

5. Service Coordinator's Name

6. SSN

7. UPDATE 2 – Date Completed

8. UPDATE 1 – ISP Date

II. Addition PAS Hours Not Identified on Form 2060

 

Not Applicable (Skip to Section IV)

A.

 

B.

C.

D.

 

 

 

Number of Minutes

X

Number of Days

= Total Minutes

 

Applicable as Follows

Comments

 

Per Day

 

Per Week

Per Week

 

 

 

 

 

 

 

 

 

1.

 

Protective Supervision

 

X

 

=

 

 

 

 

 

 

 

 

 

2.

 

Extension of Therapy

 

X

 

=

 

 

 

 

 

 

 

 

 

 

 

Purchased Delegated Nursing

 

 

 

 

 

3.

 

Tasks (monthly hrs. from 3671

 

X

 

=

 

 

C, Section II, 12D divided by

 

 

 

 

 

4.33)

 

 

 

 

 

 

 

 

 

 

 

 

 

4.

 

CDS and other delegated

 

X

 

=

 

 

 

nursing tasks to PAS

 

 

 

 

 

 

 

 

 

 

 

 

 

E. Totals PAS Minutes per Week =

III.Comments (4 lines):

IV. PAS Time Totals

UPDATE 1

UPDATE 2

 

DETAILED INSTRUCTIONS

 

 

 

 

1.

1.

1.

Minutes per Week from Form 2060 – Enter the total minutes from Form 2060, if applicable, without deductions for VA A&A.

 

 

 

 

2.

2.

2.

Minutes per Week from this Form 2060-MC – Enter the total PAS minutes from this form (Section II, E. above).

 

 

 

 

3.

3.

3.

Total Minutes per Week – Add Box 1 (Minutes from 2060) to Box 2 (Minutes from 2060-MC) and enter the sum.

 

 

 

 

4.

4.

4.

Total Hours – Divide Box 3 (Total Minutes per Week) by 60, round up to the next higher half hour, and enter total.

 

 

 

 

5.

5.

5.

A&A and TPR Hours – Add any VA A&A monetary amounts (from Form 2060) to any payment from other TPR (from Form

8598). Divide total by 4.33 to determine weekly amount, then divide weekly amount by PAS hourly rate; enter total.

 

 

 

 

 

 

6.

6.

6.

Adjusted Weekly Hours – Subtract Box 5 (A&A/TPR Hours) from Box 4 (Total Hours) and enter the remainder; round up to

next higher half hour.

 

 

 

 

 

 

7.

7.

7.

Hours Authorized per Year – Multiply Box 6 (Adjusted Weekly Hours) by the number of weeks remaining in the ISP year,

round up to the next hour, and enter total. (See Form 2060 instructions if rounding to next hour exceeds limit.)

 

 

 

 

 

 

8.

8.

8.

Hours Previously Authorized this ISP Year – Enter the number of hours scheduled to have been delivered up until the

effective date of this ISP change based on the previous authorization for this ISP year, if applicable.

 

 

 

 

 

 

9.

9.

9.

Estimated Annual PAS Authorization - Enter the sum of Box 7 (Hours Authorized per Year) and Box 8 (Hours Previously

Delivered) and enter the total on Form 3671-1, Service Code 17 (round up to next hour).

 

 

 

 

 

 

V. Certification by Interdisciplinary Team Members: The waiver services identified above for this applicant/member are necessary to prevent nursing facility placement and are appropriate to meet the needs of the applicant/member in the community.

UPDATE 1

Applicant/Member/Responsible Party and Service Coordinator signatures on Form 3671-2 at initial certification and annual redetermination

Signature – Service Coordinator

 

Date

 

Signature – Applicant/Member/Responsible Party

 

Date

 

 

 

 

 

 

 

Signature – MCO Representative

 

Date

 

 

 

 

UPDATE 2

Applicant/Member/Responsible Party and MCO Service Coordinator signatures on Form 3671-2 at initial certification and annual redetermination

Signature – MCO Service Coordinator

 

Date

 

Signature – Applicant/Member/Responsible Party

 

Date

How to Edit Form 2060 Mc Online for Free

With the online editor for PDFs by FormsPal, it is possible to fill out or edit 12D here and now. In order to make our editor better and more convenient to utilize, we consistently implement new features, with our users' feedback in mind. To get the process started, go through these simple steps:

Step 1: First of all, access the tool by clicking the "Get Form Button" above on this webpage.

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With regards to the blanks of this specific PDF, here is what you should do:

1. You will need to complete the 12D properly, therefore be mindful while filling in the sections containing these specific blanks:

A way to fill out TPR stage 1

2. Now that the previous section is complete, it is time to put in the required details in Minutes per Week from Form, Minutes per Week from this Form, Total Minutes per Week Add Box, Total Hours Divide Box Total, AA and TPR Hours Add any VA AA, Adjusted Weekly Hours Subtract, Hours Authorized per Year, Hours Previously Authorized this, Estimated Annual PAS, V Certification by, UPDATE, and ApplicantMemberResponsible Party so you're able to move on to the next stage.

How one can prepare TPR portion 2

It's very easy to make an error while filling out the AA and TPR Hours Add any VA AA, consequently make sure that you take another look prior to deciding to send it in.

3. Completing Signature Service Coordinator, Signature MCO Representative, Date, Date, Signature, Date, UPDATE, ApplicantMemberResponsible Party, Signature MCO Service Coordinator, Date, Signature, and Date is essential for the next step, make sure to fill them out in their entirety. Don't miss any details!

Filling in part 3 of TPR

Step 3: Just after proofreading your completed blanks, click "Done" and you're good to go! Join FormsPal now and instantly use 12D, prepared for downloading. All changes made by you are saved , helping you to customize the pdf further if needed. At FormsPal, we aim to guarantee that all your information is stored secure.

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