Are you considering filing a Form DDS ACS 104? You may be unfamiliar with the form, or questioning what it’s used for and how to complete it. Today we’ll provide an overview of everything you need to know about Form DDS ACS 104: from its purpose and contents, to who must file it and other important filing information. Our hope is that by taking some time now to learn more about this form you can make the process smoother in the long run!
| Question | Answer |
|---|---|
| Form Name | Form Dds Acs 104 |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | assistive, Ext, acs, areas |
Arkansas Department of Human Services
Division of Developmental Disabilities Services
ACS WAIVER AREAS OF NEED
Waiver Individual Name:
NOTE: This page will only need to be completed at initial ICF level of care determination and age milestones. Annually for minors birth
years; every 3 years for minors age
goals for the area is not sufficient. This explanation must provide information concerning what the person cannot do for themselves. Compare children to peers not adults. What is the child not able to do that his/her peers can do? Describe only areas in which the individual experiences problems and/or challenges.
1.Self Care: Ability for own toileting, grooming, dressing, and eating needs.
2.Understanding and use of language: Ability to communicate needs and respond to others.
3.Learning: Ability to process, retain and apply information appropriately in different situations.
4.
Mobility: Ability to move self from place to place by walking or with assistive device (s).
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6.
Capacity for Independent Living: Ability to learn to cook, shop, clean and maintain self in an independent living situation.
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DDS ACS 104 (Effective: 03/01/10)