Form Ddd-1753a Forpdf - Policy And Procedure Focused Review: Responsible Driving Tool/transporting Members Page 2

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DDD-1753A FORPDF (3-17) – Reverse
QUALIFIED VENDOR NAME
POLICY REVIEW DATE
SERVICE(S)
Policy Review Disposition:
Policy is accepted by the Division.
Policy is not accepted by the Division. Please review the areas marked “No” on page 1 of this document. Revise your
agency’s Policy to include the missing components.
The revised policy will need to be submitted to
by
No Policy was submitted. Please develop a policy including the components from page 1.
The policy will need to be submitted to
by
Comments:
Contract Monitoring Follow-Up Review Results:
Date of Review:
Revised Policy is accepted by the Division.
Revised Policy is not accepted by the Division. If not accepted, elevate to Unit Supervisor/Manager for further
follow-up.
Vendor does not have a Policy in place. If no Policy was developed, elevate to Unit Supervisor/Manager for further
follow-up.
Comments:
Equal Opportunity Employer/Program • Under Titles VI and VII of the Civil Rights Act of 1964 (Title VI & VII), and the
Americans with Disabilities Act of 1990 (ADA), Section 504 of the Rehabilitation Act of 1973, the Age Discrimination Act of
1975, and Title II of the Genetic Information Nondiscrimination Act (GINA) of 2008; the Department prohibits discrimination in
admissions, programs, services, activities, or employment based on race, color, religion, sex, national origin, age, disability,
genetics and retaliation. To request this document in alternative format or for further information about this policy, contact
the Division of Developmental Disabilities ADA Coordinator at 602-542-0419 TTY/TDD Services: 7-1-1. • Free language
assistance for DES services is available upon request. Ayuda gratuita con traducciones relacionadas con los servicios del
DES está disponible a solicitud del cliente.

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