Respite Approval Request
Respite requests will typically be processed within 5 business days depending on their complexity. If you have not heard a response within 10 business days, please email corinna.barrack@state.co.us

If you have any questions or concerns about your request, please email corinna.barrack@state.co.us

This form will ask the following types of questions:
1. General case management information
2. General Member information & service plan specifics (PA#, was respite utilized before, what percent utilization)
3. Specific request information: type of support the family has (natural supports, waiver services, CNA/Home health), how is the household managing without respite, other members in the household receiving HCBS services
4. Total units of respite requested

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Case Management Agency 
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Agency Contact (Case Manager) Name *
Agency Contact Email 
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Agency Contact Phone Number
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