Mi Via creates the following publications and forms, choose from the links below. Note: Document Download time may vary.
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Appointment of Authorized Agent Form Instructions v3-03022012
(3/2/2012, added
4/11/2012)
Authorized Agent Form 03022012 (3/2/2012, added
4/11/2012)
Mi Via Emergency Back-Up Plan Acknowledgement Form
(4/25/11, added
4/26/11)
Mi Via Service & Support Plan (4/25/11, added 4/26/11)
Transition to a Different Consultant Agency (11/19/10; Revised
12/21/10; Final 1-11-11; Added 1/25/11)
This defines the process if you want to choose another Consultant Agency.
Letter of Records Transfer to new consultant agency (12/21/10; Final 1-11-11; Added 1/25/11)
New 2-week Timesheet (11/18/10; posted 12/14/10)
ACS Toolkit for completing timesheets (11/22/10; posted 12/14/10)
Effective as of February 13, 2012, the State of New Mexico is no longer requiring the Federal I-9 Form be submitted to ACS for processing as part of the Employee Packet click here for more information. (03/16/12; posted 03/16/12)
Range of Rates and Codes (Revised 7/1/10, updated 11/10/10 added 11/29/10)
effective 10/25/10
Payment Request Form (Revised 8/16/10, added 10/27/10)
Mi Via Explanation Letter to Vendors for Mi Via Goods and Services (3/27/08; Updated and Added 8/26/10)
New ACS Letter to participants, new paycheck/payment style (Added 6/21/10)
Request for Services by Legally Responsible Individuals - Revised Form (Revised 12/2/10; Added 1/24/11)
Under some circumstances, a Legally Responsible Individual (biological or adoptive parent of a child under age 18 or spouse of an adult participant) may request to provide and be paid for services for their child or spouse. Participants may use the Request for Services by Legally Responsible Individuals form to make that request. The form must be submitted with the Service & Support Plan.
Brain Injury Checklist, Financial Eligibility (Updated 8/25/2008)
Individuals with a brain injury may be eligible to apply for the Mi Via Self-Directed Waiver. The Brain Injury Checklist guides individuals through the process of determining financial eligibility.
Brain Injury Checklist, Medical Eligibility (Updated 7/09)
Individuals with a brain injury may be eligible to apply for the Mi Via Self-Directed Waiver. This checklist guides individuals through the process of determining medical eligibility.