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Independent Choices Program (ICP)

Oregon Administrative Rules

OAR 411-030-0100

Tools

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 (Updated 12/11/2019)

Forms

ICP Forms Processing Chart

ICP Participation Agreement (English) Form DHS 2876 Also available in the following languages - (Updated 10/2019)

Arabic | Chinese Simplified | Korean | Romanian | Russian | Somali | Spanish | Vietnamese

Representative Agreement

Payment Coupon for Workers' Benefit Fund Assessment

Notice of Eligibility and Responsibility (English) Form APD 0541 Also available in the following languages -

Russian | Spanish | Romanian

Notice of ICP Payment Ending (English) Form SDS 0540ICP Also available in the following languages -

Arabic | Chinese Simplified & Traditional | Korean | Russian | Somali | Spanish | Vietnamese | Romanian | English LP | Spanish LP

ICP Benefit Calculation 2 Week Authorization (English) Form SDS 0546IC2Wk Also available in the following languages -

Arabic | Chinese Simplified | Korean | Romanian | Russian | Somali | Spanish | Vietnamese

ICP Employee Provider(s) Information (English) Form APD 0548 Also available in the following languages -

Arabic | Chinese Traditional | Korean | Romanian | Russian | Somali | Spanish | Vietnamese

Workers Compensation Consent and Agreement (English) Form APD 0353 Also available in the following languages -

Arabic | Chinese Simplified | Korean | Romanian | Russian | Somali | Spanish | Vietnamese

ICP Request for Direct Deposit (DHS 7262I)

Budget and Payroll Forms and Samples

Budget Worksheet Print Version (Updated 11/06/2019)
Budget Worksheet Digital Version (Updated 11/06/2019)
Budget Worksheet Instructions
Completed Budget Worksheet - Sample
Six Month Budget Review Checklist

Coding for ICP

Acumen -- NEW

Acumen Referral Form
Acumen Referral Fact Sheet
Acumen FAQs (New 12/13/2019)
Acumen Introduction Power Point Material
Acumen Introduction Webinar Recording with Audio
Acumen Trifold Brochure
Acumen Request for Vendor Payment/Reimbursement Form
Acumen ICP Employer Forms (FYI only - Acumen will work with ICP participants to complete enrollment forms.)
Acumen ICP Provider Forms (FYI only - Acumen will work with ICP providers to complete forms.)

Resources & Checklists

Web Links

For ICP information, please contact Christine Maciel, ICP Policy Analyst at (541) 471-3830, email at: Christine.C.Maciel@state.or.us or icp.spd@state.or.us

Transmittals

Transmittal #	Date	Title
APD-AR-19-056	12/20/19	Action: Independent Choices Program (ICP) Benefit Calculation Form Updated Due to Wage Increase and Wage Increase and WBF Rate Change for 2020
APD-IM-19-017	03/29/19	Info: New Fiscal Intermediary 'Acumen' for Independent Choices Program (ICP) Participants (Voluntary Program)
APD-PT-19-013	03/29/19	Policy: Independent Choices Program Cash Benefit Requirement Change
APD-IM-19-016	03/28/19	Info: Changes to the APD Receipting Solutions (APDRS)
APD-IM-19-006	01/23/19	Info: Independent Choices Program 2019 Taxes
OPAR-IM-18-002	04/24/18	Info: CMU Client Direct Deposit Procedure Changes
APD-IM-18-028	03/26/18	Info: Independent Choices Benefit Calculation form updated due to wage increase for 2018
APD-IM-17-095	12/29/17	Info: No new Independent Choices Program Benefit Calculation form needed
APD-AR-17-060	09/22/17	Action: Updated Independent Choices Benefit Calculation form due to Live-in Services closing and two week authorizations
APD-IM-17-053	07/14/17	Info: Letter for Individuals Currently Receiving Live-in Services
APD-AR-17-037	06/26/17	Action: Independent Choices Benefit Calculation form updated due to wage increase for 2017
APD-PT-17-019	06/15/17	Policy: In-Home Services Live-in Option Closure
APD-AR-17-002	01/19/17	Info: Independent Choices Benefit Calculation form updated due to wage increase for 2017satt
APD-IM-16-105	11/17/16	Info: UPDATED Direct Deposit form (DHS 7262i)
APD-AR-16-064	08/31/16	Action: In-home Service Options brochure
APD-AR-16-047	07/01/16	Action: Independent Choices Benefit Calculation form updated due to minimum wage increase
APD-PT-16-020	05/26/16	Policy: Homecare workers acting as consumer representatives *(Corrected)*
APD-IM-15-115	12/28/15	Info: UPDATED Independent Choices Benefit Calculation form (546ic)
APD-AR-15-076	12/23/15	Action: Indepenedent Choices Benefit Calculation form updated due to wage increase and tax rate changes for 2016
APD-PT-15-025	07/28/15	Policy: New Authorization Criteria for Live-in/Shift Services under the In-Home Services Program, Including the Independent Choices Program and Spousal Pay Program
APD-AR-14-076	12/24/14	Action: Independent Choices Benefit Calculation form updated due to wage increase and tax rate changes
SPD-AR-10-118	12/20/10	Action: Independent Choices Benefit Calculation Form Update and Workers' Compensation Forms
SPD-AR-10-117	12/20/10	Action: Workers' Compensation Consent and Agreement Form (SDS 0353)
SPD-IM-10-069	09/07/10	Action:Worker's Compensation Insurance for employee providers in the Independent Choices Program

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.