OSA Waiting List Management Report Form

         
Select Agency:
Fiscal Year:
FY Quarter:
Completed By:
Date:

Section II. Waiting List Management Practicies/Polices:

NOTE – This section is to be filled out for the 1st quarter waiting list report. AAAs do not need to complete this section after the first quarter, unless there has been a change regarding any of the questions below.

Home Delivered Meals Waiting List
1. Please describe the information that is collected on individuals that are placed on the home delivered meals (HDM) waiting list:
    Name
    Contact information
    Services interested in/likely eligible for
    Other (please describe below):
    
2. How often is the HDM waiting list reviewed (e.g., to determine when an individual should be removed from the list)?
    Monthly
    Quarterly
    Annually
    Other (please describe):
    
3. Please describe the HDM waiting list review/update process:
  
4. Describe the process (if any) by which individuals are prioritized for placement on the HDM waiting list:
    Local AAA screening tool
    Local service provider screening tool
    No prioritization – first come first serve
    Other (please describe):
    

In Home, Access, and Priority Service Waiting List
5. Please describe the information that is collected on individuals that are placed on the in home, access, and priority service waiting list:
    Name
    Contact information
    Services interested in/likely eligible for
    Other (please describe below):
    
6. How often is the waiting list reviewed (e.g., to determine when an individual should be removed from the list)?
    Monthly
    Quarterly
    Annually
    Other (please describe):
    
7. Please describe the review process:
  
8. Describe the process (if any) by which individuals are prioritized for placement on the in home, access, and priority service waiting list:
    Local AAA screening tool
    Local service provider screening tool
    No prioritization – first come first serve
    Other (please describe):