An applicant seeking respite care services shall apply to the provider of the services. If the local department does not provide the services, it shall refer the applicant to the DHS respite care provider in their area or to another appropriate provider. The provider shall inform the applicant about the eligibility requirements, rights, and obligations under the program. The applicant shall complete the application on a form approved by the Administration. The completed application shall include: The date of application; The name of the individual with the developmental or functional disability; The address of the applicant, and phone number, if any, of the nearest phone for emergencies; The name and address of the informal caregiver; The school or day program in current use by the individual with the developmental or functional disability; The living arrangement of the applicant, including information about the household composition; Other current state or county services used by the consumer; The amount and source of total income; Medical or psychological information by a licensed health care provider which enables the respite care provider agency to determine that the applicant is an individual with a developmental or functional disability and the type and level of care needed; The name, address, telephone number, and relationship of the applicant to the individual with the developmental or functional disability; and Authorization for the release of medical and psychological information. Notice to Applicant. Within 30 days after receipt of the application the provider shall notify the applicant in writing that the application is incomplete, has been accepted, or has been denied. If the application is incomplete, the notice shall state: The parts of the application which have not been completed; and That if the application is not completed within 30 days, the provider is required to deny the application. If the application is accepted, the notice shall state: The amount of services to be delivered; The type and level of service to be delivered; The schedule for use of the service; The amount of any fee to be paid; That eligibility and financial status are redetermined if a change occurs that might affect the eligibility or financial status, and at least every 12 months; That the service statement is reviewed and amended if a change occurs, and at least every 12 months; and The right to, and method for, obtaining a fair hearing. If the applicant is denied, the notice shall state the: Reason for denial; Specific regulation supporting the decision; and The right to, and method for, obtaining a fair hearing. The provider shall deny the application if: The medical or psychological information does not indicate that the applicant is an individual with a developmental or functional disability, or is a family member or informal caregiver of a person with a developmental or functional disability; The application remains incomplete 30 days after notice to the applicant under §B(2) of this regulation. Respite care services may be provided for an individual with a developmental or functional disability in a crisis situation before completing the application, at the discretion of the provider.