Community ties of america 2026

1. Click ‘Get Form’ to open the Substitute Caregiver Change Notification form in the editor.
2. Begin by entering the Primary Caregiver’s Name and Phone number in the designated fields. Ensure that your contact information is accurate for any follow-up communications.
3. Fill in the Physical Address and, if applicable, the Mailing Address. This information is crucial for official correspondence.
4. Indicate how many beds you are certified for by entering a number in the provided field. If you are certifying a three-bed home, remember to attach a completed job experience form.
5. For each Substitute Caregiver (SCG), provide their name and circle whether they are being added or removed from your care team. Include their Date of Birth and select their qualifications (CNA, LPN, RN).
6. If adding an SCG, enter the date they were approved by CTA. Review all entries for accuracy before proceeding.
7. Sign and date the form as the Primary Caregiver, acknowledging your responsibilities regarding SCG training and compliance with regulations.
8. If adding an SCG, ensure they read and sign the acceptance statement regarding their responsibilities before submitting the form.

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