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Home and Community Based Services
Forms and Information

Quarterly reports are due 30 days after each quarter ending:

 

1st quarter - July 1 - September 30

2nd quarter - October 1 - December 31

3rd quarter - January 1 - March 31

4th quarter - April 1 - June 30

 

Quarterly reports may be mailed, faxed or emailed to the grant administrator listed below. Please mail, fax or scan original signature pages.

Grants and Contracts Support Team
P.O. Box 110650
Juneau, AK
99811-0650
Fax: (907) 465-3419

  • SIH and NFCSP:
    Marlyn Carrillo, Grants Administrator
    Phone: (907)465-3026
  • Adult Day:
    Stephen Bower,Grants Administrator
    Phone: (907)465-6924

Adult Day Services

Senior In–Home Services

  • SIH Grant Program Manual (PDF)
  • SAMS HCB Registration Form (Word)(PDF)
  • FY13 SIH Biannual Report Narrative (Word)(PDF)
  • FY13 SIH CFR 2 - Expenditures by Service Category (Excel)
  • SIH Case Management Assessment Form (Word)
  • SIH Plan of Care Form (Word)
  • SIH Supplemental Services Request Form (Word)
  • SIH under 60 Eligibility Determination Worksheet (Word) (PDF)

National Family Caregiver Support Program

SAMS (Social Assistance Management Software)

  • 2014 HCB Senior Grants Data Entry Manual (PDF)

     

    Program Manager

    Adult Day, Senior In-Home Services, National Family Caregiver Support:
    Eric Wharton

    Health Program Manager II
    DHSS/Senior and Disabilities Services/Senior Grants Unit
    PO Box 110680,
    Juneau, Alaska 99811-0680
    Phone: (907) 465-5810
    Fax: (907) 465-1170