Personal Support, Agency-Based

What is it?

Personal Support, Agency-Based, provides services that include training and assistance to enable participants to accomplish tasks that they would normally do for themselves if they did not have a disability.  These services may include:

• Teaching adaptive skills to assist the individual to reach personal goals.
• Personal assistance in activities of daily living.
• Assistance in performing age-appropriate housekeeping chores (bed-making, dusting, vacuuming) that are essential to the health and welfare of the individual.

Personal Support Services, Agency-Based, must be documented in the individual's service plan, and service authorizations must specify the monthly number of hours and the hourly rate.

1. You must have staff with required qualifications and training.

2. You Must Submit These Documents To Your Region Facilitator: 

   • Letter of Interest
   • Waiver Program Provider Agreement  (HFS 1413A)
     • Instructions for HFS 1413A
   • Provider Enrollment Application (HFS 2243)
     • Instructions for HFS 2243 
   • Provider Information Form (IL462-1246)
   • IRS W-9 form and Guidelines
   • FTP Registration Request Form 
   • Community Provider User ID and System Access Request  (IL444-2022)

3. Contract Information

   Upon meeting the specified requirements above, aCommunity Service Agreement and Attachment A will be sent to you, containing your specific agency information.

   NOTE:  A contract is not final until it is signed by the DHS Secretary.

4. You Must Submit DSP Training Programs for Approval

   With an approved contract, you must submit DSP training programs to:

   Illinois Department of Human Services
   Division of Developmental Disabilities
   Bureau of Quality Management
   319 E. Madison, Suite 4J
   Springfield, IL  62701

   Attention: DSP Training Program

   • DSP program training approval process 

Important Resources For Requirements