More links and information regarding the EVV process will be added shortly. Please keep checking this page for updates. We appreciate your patience in this matter.
Live-In Caregiver Attestation Form
Please click HERE to find the Live-In Caregiver Attestation form.
- Per the instructions on page one (1), two (2) of the following documents are required with submission of this form.
- Valid Michigan driver’s license
- Valid Michigan state identifcation
- Utility bill or credit card statement issued within the last 90 days
- Account statement from a bank or other financial institution issued within the last 90 days
- Mortgage, lease or rental agreement
- Lease and rental agreements must include the landlord’s telephone number
- Pay stub or earnings statement issued with in the past 90 days
- Life, health or auto insurance policy
- Current Michigan title and registration
- Federal, state or local government documents (i.e. receipts, licenses or assessments)
- Please make sure that all instructions on the form are followed.
- Lifelong does NOT have the authority to grant exemptions.
- Please send completed form to Lifelong via email, fax or drop it off at the office/secure drop box.
- Once the form is received by MCCMH, they have 10 calendar days to provide a decision to the FMS, caregiver and person served.
- The form needs to be resubmitted every year to continue the exemption.