Elements of the application filing (Repealed)

(a) Any person may obtain an application by contacting the nearest district office of the Department. Application forms shall be mailed to anyone upon request. (b) The applicant shall be responsible for submitting a completed application which shall include but not be limited to the following: (1) A record of severe physical disability, including documentation such as statements from nurses(s), doctor(s), and/or other health professionals, (2) Wage stubs for the last six (6) weeks, (3) A copy of the federal income tax return filed for the previous year, (4) Copies of Social Security or other benefit checks, and other sources of documentation which clearly establish gross family income, (5) Evidence of being employable, (6) A personal care assistance plan including hours, costs, scope of care needed in order for applicant to become or to remain employed, and the extent to which the applicant currently uses personal care assistance, and (7) Any additional reports or information that he or she feels will assist in the determination of eligibility.