Independent Choices Program (ICP)

OAR 411-030-0100

ICP Worker Guide

ICP Participant Handbook

ICP Letter to Participants Explaining Discontinuing Requirement to Return Cash Benefit

Program Descriptions & Brochures

• Program Overview for Consumers
• Program Outline for Staff
• ICP Brochure (SDS 9057)
• FAQ - Workers' Compensation and Benefit Fund Assessment
• Workers' Benefit Fund Assessment Rate

Forms

ICP Forms Processing Chart

ICP Participation Agreement (English) Form DHS 2876

Representative Agreement

Payment Coupon for Workers' Benefit Fund Assessment

Notice of Eligibility and Responsibility (English) Form APD 0541

Notice of ICP Payment Ending (English) Form SDS 0540ICP

ICP Benefit Calculation 2 Week Authorization (English) Form SDS 0546IC2Wk

ICP Employee Provider(s) Information (English) Form APD 0548

Workers Compensation Consent and Agreement (English) Form APD 0353

ICP Request for Direct Deposit (DHS 7262I)

Budget and Payroll Forms and Samples

• Budget Worksheet Print Version
• Budget Worksheet Digital Version
• Budget Worksheet Instructions
• Completed Budget Worksheet - Sample
• Six Month Budget Review Checklist

Coding for ICP

Acumen - Customer Service Phone Number (866) 235-4745

• Acumen Referral Form
• ICP Participant Letter with EVV Information
• Acumen Referral Fact Sheet
• Acumen EVV FAQs Brochure
• Acumen FAQs
• Acumen Introduction Power Point Material
• Acumen Introduction Webinar Recording with Audio
• Acumen Trifold Brochure
• Acumen Request for Vendor Payment/Reimbursement Form
• Acumen ICP Employer Enrollment Forms
  • ICP Employer EVV Only 'Good to Go Notification' (FYI only-Acumen sends out when enrollment is completed) (New 12/22/2020)
  • ICP Employer EVV Only 'Welcome Letter' (FYI only-Acumen sends out when enrollment is completed) (New 12/22/2020)
  • ICP Employer 'How to Approve/Review Time in the Web Portal' (FYI only-Acumen sends out when enrollment is completed) (New 12/22/2020)
  • ICP Employer EVV Email Template (FYI only-Acumen sends out when enrollment is completed) (New 12/22/2020)
• Acumen ICP Provider Enrollment Forms (FYI only-Acumen will work with ICP providers to complete forms.)
  • ICP Employee Provider EVV Only 'Good to Go Notification' (FYI only-Acumen sends out when enrollment is completed) (New 12/22/2020)
  • ICP Employee Provider 'Time Entry Instructions' (FYI only-Acumen sends out when enrollment is completed) (New 12/22/2020)
  • ICP Employee Provider EVV Only 'Time Entry Report Schedule for 07/2020 - 06/2020' (FYI only-Acumen sends out when enrollment is completed) (New 12/22/2020)

ICP FAQ Podcasts (Note: Please listen to the Podcast in Firefox or Microsoft Edge)

• ICP FAQ Podcast 1.0 Recording (New 01/06/2021)
• ICP FAQ Podcast 1.0 Script (New 01/06/2021)

Resources & Checklists

• ICP Bookkeepers List
• ICP Checklist
• ICP Screening Tool
• What To Do If You Are Injured On The Job
• Who To Call Contacts

Web Links

• Oregon Home Care Commission - Personal Support Worker Tools
• IRS and Tax Info
• Work Source Oregon for Job Info
• AARP Tax Aide

For ICP information, please contact Christine Maciel, ICP Policy Analyst at: Christine.C.Maciel@dhsoha.state.or.us or icp.spd@dhsoha.state.or.us

If you have a disability and need a document on this Web site to be provided to you in another format, please contact the Office of Document Mangement (ODM) at 503-378-3486 or by e-mail at dhs.forms@state.or.us.

If you have questions about DHS or problems getting DHS services, send e-mail to dhs.info@state.or.us. If you have comments about this site, send e-mail to spd.web@state.or.us.

Oregon Department of Human Services
500 Summer St. NE E02, Salem, OR 97301-1073
Phone: (503) 945-5811
Toll-free: (800) 282-8096 (V/TTY)