Effective Date
Instructions
Updated: 5/2026
Purpose
To provide information to the person requesting services, the person receiving ongoing services or their legally authorized representative (LAR) about the added responsibilities of being an employer in the Consumer Directed Services (CDS) option and who may or may not be hired to provide services.
Procedure
When to Prepare
Complete this form after the person reviews Form 1581 Consumer Directed Services (CDS) Option Overview and Form 1582 Consumer Directed Services Responsibilities and elects to participate in CDS.
Number of Copies
One original and one copy.
Form Retention
Retain a copy of Form 1583 in the case folder.
Transmittal
After the information is reviewed, the case manager or service coordinator gives the original Form 1583 to the person.
Detailed Instructions
The case manager service coordinator reviews with the person:
Pages 1 – 2 — Employee qualification requirements, employer and employee relationship requirements, and employer and employee relationship definitions in CDS.
Person or LAR’s Signature and Date — The person or their LAR signs and dates the form to indicate the case manager or service coordinator presented this information.
Case Manager or Service Coordinator Signature and Date — The case manager or service coordinator signs and dates the form to verify the information was presented to the person and their LAR, if they have one.