Sample Memorandum Of Agreement printable pdf download

Sample Memorandum Of Agreement

D R A F T

Sample

Memorandum of Agreement

Between the

[name of ADRC]

and the

[name of ILC]

Purpose

The following is an agreement between the Aging and Disability Resource Center of

[ADRC name here] and [ILC name here].

The purpose for this Memorandum of Agreement (MOA) is to recognize the

interconnected and complementary nature of the services provided by the Aging and

Disability Resource Center (ADRC) and the Independent Living Center (ILC) and to

define the roles, responsibilities and procedures for collaboration between ADRC and

ILC.

The period of this agreement begins on [insert date] and continues until amended or

terminated.

II.

Roles and Responsibilities

Referrals for Service

The ILC will refer customers to the ADRC for services such as:

Information and assistance where ADRC services can complement or augment

those provided by the ILC,

Long-term Care Options counseling

Disability and elderly benefits counseling,

Access to publicly funded long term care, including administration of the long

term care functional screen,

Any other ADRC service that may benefit the consumer, and

Individual advocacy.

The ADRC will refer customers to the ILC for service such as:

Individual and systems-level advocacy,

Assistive technology services,

Work Incentives Benefits Counseling,

Peer support,

Independent living skills training

[list any additional services the ILC provides and indicate those for which a fee is

charged].

Where the same or similar services are provided by an agency other than the ILC, the

ADRC shall act in the best interest of the customer and shall be under no obligation to

make exclusive referrals to the ILC or ILC-related vendor.

Sample Memorandum Of Agreement