MARC CLIENT INTAKE FORM - NATIONAL FAMILY CAREGIVER SUPPORT - marc 2026

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by filling out the Client Information section. Enter your last name, first name, middle initial, gender, date of birth, and social security number. Ensure all fields are completed accurately.
  3. Provide your address details including city and zip code. Select your county and marital status from the options provided.
  4. In the Eligibility section, indicate if you are a Family Caregiver over or under 60 years old and specify your relationship to the care recipient.
  5. Complete the Primary Emergency Contact and Second Emergency Contact sections with accurate information about each contact person.
  6. Fill out the Referral Information section by checking any relevant services that apply to you or the care recipient.
  7. Assess your Nutritional Status by answering the questions honestly and calculating your total score for risk level.
  8. Finally, review all entries for accuracy before signing and dating the form at the bottom.

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2022 National Strategy to Support Family Caregivers. The National Strategy identifies 350 actions the federal government can take to support family caregivers and more than 150 actions that can be adopted by states, local governments, and the private sector to build a system to support family caregivers.
Some states require employers to offer family leave programs and some programs pay you to care for a family member. The eligibility requirements, the amount you will receive to provide care, and how long you can take off work varies by state. To learn more, contact your state labor office.
Does Medicare pay for caregivers? Medicare does not offer reimbursement for family caregivers. It also doesnt provide payment for long-term care services like in-home care or adult day services.
The National Family Caregiver Support Program (NFCSP), established in 2000, provides grants to States and Territories, based on their share of the population aged 70 and over, to fund a range of supports that assist family and informal caregivers to care for their loved ones at home for as long as possible.
Thirteen statesCalifornia, Colorado, Connecticut, Delaware, Maine, Massachusetts, Maryland, Minnesota, New Jersey, New York, Oregon, Rhode Island, and Washingtonand the District of Columbia have enacted laws that provide paid family leave for employees who need time off to care for family members who are ill or have

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