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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
Fax: (907) 465-3419

  • SIH and NFCSP:
    Marlyn Carrillo, Grants Administrator
    Phone: (907)465-3026
  • Adult Day:
    Alyssa Hobbs, Grants Administrator
    Phone: (907)465-1187

Adult Day Services

Senior In–Home Services

  • SIH Grant Program Manual (PDF)
  • SAMS HCB Registration Form (Word)(PDF)
  • 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)

Program Manager

Adult Day, Senior In-Home Services, National Family Caregiver Support:
Conor O'Dea

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