Cost Statement Forms

The forms below are for work services (formerly Habilitation) providers to report all revenue and expenses biennially to the Department.

The Excel forms can be downloaded and complete using Microsoft Excel spreadsheet program. For further information, please read the instructions accompanying each form.

DS 1950 – Habilitation Services Cost Statement Forms

DS 1966 – Request for Rate Adjustment — Occupancy Change

DS 1967 – Request for Rate Adjustment — Staffing Change


Last modified: April 15, 2024