Skip to main content

DAIL Housing Accessibility Assessment Forms

DAIL Housing Pre-Inspection for Accessibility Assessment (Fillable Form) - The DAIL Housing Pre-Inspection for Accessibility Assessment form is used by the Providing Agencies in the pre-inspection of a home, prior to contacting the DAIL Contractor to schedule a Accessibility Assessment.  (Non-Fillable) DAIL Housing Pre-Inspection for Accessibility Assessment form

     SAMPLE- DAIL Housing Pre-Inspection for Accessibility Assessment

Agency Accessibility Modification Plan (Fillable Form) - The Provider Agency is responsible for overseeing the implementation of a plan to initiate the home modifications and overseeing the completion of the modification(s).  This is a resource the agency may use to keep track of the progress of the plan.
(Non-Fillable) Agency Accessibility Modification Plan

Agency Accessibility Modification Plan, ATTACHMENT - This is a supplemental form for Agency Accessibility Modification Plan, when additional space for listing Assessment items is needed.
(Non-Fillable) Agency Accessibility Modification Plan, ATTACHMENT

DAIL_Housing-Accessibility_Modification_Reimbursement_Form - This form is required when requesting modification reimbursement.  Additional information and resources for requesting home modification reimbursement:  DAIL Housing Accessibility Modification Reimbursement Information and Notification process -