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California Department of Developmental Services1600 9th Street
P. O. Box 944202
Sacramento, CA 94244-2020
Info: (916) 654-1690
TTY: (916) 654-2054
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Documents identified by PDF (Portable Document Format) requires the Adobe Acrobat Reader to be viewed and printed. If you do not already have the Adobe Reader, it can be downloaded for free from Adobe.
Work Services Cost Statement Forms
The forms below are for work service (formerly Habilitation) providers to report all revenue and expenses biennially to the Department.
The Excel forms can be downloaded and completed using the Microsoft Excel spreadsheet program. For further information, please read the instructions accompanying each form.
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DS 1950 - Habilitation Services Cost Statement Forms DS 1950 (3/05) (Microsoft Excel Spreadsheet with formulas) |
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DS 1966 - Request for Rate Adjustment -- Occupancy Change DS 1966 (3/05) (Microsoft Excel Spreadsheet) |
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DS 1967 - Request for Rate Adjustment -- Staffing Change. DS 1967 (3/05) (Microsoft Excel Spreadsheet) |