(click on links to forms below to view or download)

• All reports are due December 31, 2014



Please print instructions for any of the applications below prior to downloading.
NOTE: If your application does not have a printer icon , hold down Ctrl + P to print.



• For Microsoft Access 2007 or newer:



Please print instructions before beginning download

Click to download "Adult Care Cost Report application for Access"

• If you do not have a copy of Microsoft Access, please download a free RunTime version from Microsoft before continuing.

Please print instructions before submitting your cost report.

If your facility:

• Did NOT receive any State/County Special Assistance Funds
• Does NOT bill Medicaid PCS

You should submit an Exemption Form.   DO NOT complete a Cost Report.   Exemptions are due December 31, 2014.