Senior Box (CSFP) Agency Resources
Click the “+” next to each section to see associated forms.
Civil Rights
Client Benefit Resources
- Client Benefits Assistance Interest Procedures (English)
- Client Benefits Assistance Interest Procedures (Spanish)
- Benefits Assistance Interest Form (English)
- Benefits Assistance Interest Form (Spanish)
- Supplemental Security Income (SSI) Benefits
- Medicare Savings Program
- Medicare Savings Program (Spanish)
Client Handouts
CSFP Forms
- CSFP Beneficiary Referral Request (English)
- CSFP Beneficiary Referral Request (Spanish)
- CSFP Written Notice of Beneficiary Rights (English)
- Senior Box Intake Form 2022 (English)
- Senior Box Intake Form 2022 (Spanish)
- CSFP Proxy Form
- Participant Application Form H1504
- Participant Applications Instructions Form H1504
- Application Notification (H1515)
- Instructions for Application Notification (H1515)
- Participant Rights & Responsibilities (Form H1516)
- Participant Transfer Instructions
- Participant Transfer Form
- CSFP Written Notice of Beneficiary Rights (English)
- CSFP Written Notice of Beneficiary Rights (Spanish)
CSFP Training Videos
CSFP Management Tools
- Senior Program Income Guidelines 2022
- CSFP Monthly Report Tracker
- Oasis Insight Report Directions
- Senior Box Distribution Procedures – All Month Model
- Senior Box Distribution Procedures – Once a Month
- CSFP Senior Box Best Practices Checklist (English)
- CSFP Senior Box Best Practices Checklist (Spanish)
- CSFP Oasis Insight User Confidentiality Agreement
- CSFP Senior Box Steps for Signing Up A Senior Box Client
- Senior Box Pre/Post Distribution Procedures CHEAT SHEET