Form 8603-2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the date submitted at the top of the form. This is crucial for tracking your submission.
3. Select the program type by checking either 'Intermediate Care Facilities/Intellectual Disability (ICF/ID)' or 'Home and Community-based Services (HCS)'.
4. Fill in the provider name, component code, and contract number in the designated fields to identify your organization.
5. Provide contact information for both the provider and Local Intellectual and Developmental Disability Authority (LIDDA), including phone numbers and email addresses.
6. Enter individual information such as names, CARE ID No., and Medicaid No. Ensure accuracy for proper processing.
7. Indicate if any correspondence needs translation by selecting 'Yes' or 'No' and specifying the language if applicable.
8. Complete the LON increase requested section, detailing changes from initial LON to requested LON along with reasons for the request.

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