Form 4211, Respite Funding Agreement Form 4211, Respite Funding Agreement-2025

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4.8 out of 5

59 votes

The document outlines the Respite Funding Agreement for Early Childhood Intervention (ECI) Services, detailing co-pay rates based on family income and number of members. It specifies hourly rates for different levels of care (Basic, Moderate, Intensive) and includes responsibilities and conditions for families receiving respite funds. The agreement emphasizes the importance of compliance with procedures and the limitations on fund usage.

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Versions	Form popularity	Fillable & printable
2023	4.8 Satisfied (59 Votes)
2016	4.5 Satisfied (33 Votes)

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