The purpose of the links below is to share with you the fillable version of the current Congregate Care Change Report Form (LDSS-5023). Handwritten versions are sometimes blurred during transmission. OTDA hopes that the fillable form will be easier for you to complete and will allow them to process changes with fewer delays.
5023 – Fillable Congregate Care Change Report Form
Congregate Care Provider Letter – Fillable 5023
Please note that signatures are still required in Sections VII and VIII.
Thank you for your cooperation. Please contact OTDA at [email protected] if you have any questions.