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1. Click ‘Get Form’ to open the Lifespan Respite Care Grant Respite Care Provider Service Log in our platform.
2. In Section 1, provide your provider information including your name, telephone number, billing period, and address. Ensure all fields are filled accurately.
3. Move to Section 2 and enter caregiver and care recipient information. Fill in the date of service, number of hours or days provided, start and end times, and the established rates for reimbursement.
4. In Section 3, certify the accuracy of your information by checking the box and typing your name as an electronic signature. Make sure to review all details before submission.
5. Submit the completed form within 60 days by clicking the email button to send it directly to carechoice@nd.gov.

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