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CRS Individual Service Plan Guidance: Rate Documents

Return to the 1915(i) Community Recovery Services (CRS), Consumer Application Packet Guidance Home Page

Completion of both of these documents to show the breakout between “Room and Board” and “Service” as reflected on the ISP is required.

Remember: CRS reimburses the “Service” portion only, not Room and Board.

DHS Form F-20920: Calculation of Room and Board in Substitute Care Facility

  • Excel version of DHS Form F-20920 (Excel fillable, 42kb)
  • PDF version of DHS Form F-20920 (PDF fillable, 26kb)

Last Revised: June 07, 2011