Form Abp 1466 is a form used to request a review of an unfavorable determination or action that has been taken by the United States Citizenship and Immigration Services (USCIS). The form can be used to request a review of any decision made by the USCIS, including decisions on petitions, applications, and requests for benefits. If you have received an unfavorable determination or action from the USCIS, it is important to submit a Form Abp 1466 as soon as possible to request a review. failure to file the form within the required time frame may result in your case being denied. To learn more about Form Abp 1466 and how to submit it, keep reading.
| Question | Answer |
|---|---|
| Form Name | Form Abp 1466 |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | dpss grow abp 1467, DPSS, REFERRAL, ABP |
Page 1 of 2
COUNTY OF LOS ANGELES |
DEPARTMENT OF PUBLIC SOCIAL SERVICES |
GENERAL RELIEF OPPORTUNITIES FOR WORK
CLINICAL ASSESSMENT PROVIDER REFERRAL AND
SERVICE RESULTS REPORT
GROW SITE:
ADDRESS:
DATE:
CASE NAME:
CASE NUMBER:
IMPORTANT APPOINTMENT NOTICE
The following appointment has been scheduled for you
to attend a clinical assessment for mental health.
Date of Appointment:
Time:
Location:________________________________
Address:_________________________________
Phone
Number:________________________________
IT IS IMPORTANT FOR YOU TO KEEP THIS APPOINTMENT
***TAKE THIS NOTICE WITH YOU***
If for any reason you cannot keep this appointment or have a problem, please contact me immediately.
GROW CASE MANAGER: |
FILE NUMBER: |
|
PHONE NUMBER: |
|
|
|
|
|
|
SECTION A - PARTICIPANT INFORMATION |
|
|
|
|
PARTICIPANT NAME: |
|
CASE NUMBER: |
|
|
|
|
|
|
|
RESIDENCE ADDRESS: |
|
MAILING ADDRESS (CONFIDENTIAL): |
||
PRIMARY LANGUAGE: |
|
BIRTH DATE: |
|
GENDER: |
|
|
|
|
|
TELEPHONE NUMBER (CONFIDENTIAL): |
|
SOCIAL SECURITY NUMBER: |
||
|
|
|
|
|
ABP 1466 Revised 11/08 |
|
|
|
|
Page 2 of 2
SERVICE RESULTS
SECTION B - COMPLETED BY CLINICAL ASSESSOR (Please complete and return to GROW Case Manager
within five business days.)
RESULTS OF CLINICAL ASSESSMENT FOR _______________________________________________________:
PARTICIPANT NAME
‘Participant did not appear/assessment not completed.
‘Participant completed the assessment, but does not need a referral for treatment.
‘Participant completed assessment and needs a referral, but does not agree to treatment for mental health.
‘Participant completed assessment and agrees to recommended treatment for mental health. Please see below for appointment details:
Date of appointment: ______________ Location: ___________________________
Time: ___________________________ Address: ___________________________
Telephone Number: ( |
)__________ |
‘Participant does not agree with completed assessment, requests third party assessment.
RECOMMENDED THIRD PARTY ASSESSMENT PROVIDER(S): include name, address, phone
1.____________________________________________________________________________
2.____________________________________________________________________________
3.____________________________________________________________________________
ASSESSOR SIGNATURE:
DATE:
SECTION C - COMPLETED BY GROW PARTICIPANT
I authorize the release of information to DPSS regarding the results of my assessment and possible need for treatment services.
‘Yes, I agree to the service plan developed and agree to attend treatment.
‘No, I do not agree to the service plan and will not attend treatment.
_____________________________________ |
___________________________ |
GROW Participant Signature |
Date |
|
|
ABP 1466 revised 11/08 |
|