1. Complete ALL Sections (incomplete referrals may be sent back)

2. Client and Case Manager Signature required (last page)

3. Eligibility Checklist (Please do not make referral if all eligibility criteria are not met)

● If using CADI, CAC, BI or DD individual must be moving into own home (setting that individual owns, rents or leases and is not operated, owned or leased by a provider of services or supports)

● Transitional services can be authorized for up to 45 days after an individual’s move.

● Individual cannot receive transitional services if they have already had them in the last 3 years

4. PDS does not work directly with individuals receiving services.

PDS will communicate with the case manager making the referral, case managers are expected to communicate any necessary information directly to the individual who is moving. Individuals contacting us will be referred back to their case managers.

Please allow 7-10 days notice for all referrals for processing.