Opwdd universal services resort 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out the 'PERSONAL DATA' section. Enter the name, date of birth, address, and contact information for the person with a disability. Ensure all fields are completed accurately.
3. In the next section, indicate whether you have sought funding from primary medical insurance or other resources by checking 'Yes' or 'No'. Provide any results if applicable.
4. List all reimbursement amounts received this calendar year. Include agency names, dates, and amounts. If necessary, add additional pages for more entries.
5. Describe the item(s) or service requested for reimbursement in detail. Specify the total amount requested and the date of service.
6. Complete the section regarding other reimbursement agencies applied to for this request, including agency names and results.
7. Fill in details for your service coordinator or social worker, including their name, agency, email, phone number, and fax number.
8. Attach required documents as listed in the checklist section to support your application.
9. Finally, provide a detailed justification of how this request relates to the individual’s disability in Section 8. This is crucial for approval.

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