Caregiver attestation form 2026

1. Click ‘Get Form’ to open the caregiver attestation form in the editor.
2. Begin by filling out Section 1, where you will indicate your role (Individual Applicant, Spouse/SRDP Co-Provider, Entity Representative, or Resident Manager) and provide your name, the proposed adult family home's name, and its address.
3. In Section 2, the attestor must enter their personal information including name, title or role, and two contact numbers. Ensure that all fields are filled based on personal knowledge of the applicant's caregiving experience.
4. Answer questions regarding the applicant’s caregiving experience. This includes confirming if they have provided direct care to vulnerable adults and detailing their responsibilities.
5. Once all sections are completed, ensure that the form is signed and notarized as required before submission.

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