Protection and Advocacy Intake, Eligibility, and Grievance Follow-Up Organizer

A helper should use only the information needed and respect the disabled person’s choices and lawful authority.

Use exact wording when you have it. You may skip this question and return later.

State the setting, what was requested, the response, and the date. Share only the disability details needed to explain the request.

Describe what the record says and what you personally experience separately. Include frequency, duration, help needed, and aftereffects when relevant.

Use the exact date or wording from the complete document. Add the document name and page or section when you can.

State the setting, what was requested, the response, and the date. Share only the disability details needed to explain the request.

Use exact wording when you have it. You may skip this question and return later.

Describe what the record says and what you personally experience separately. Include frequency, duration, help needed, and aftereffects when relevant.

State the setting, what was requested, the response, and the date. Share only the disability details needed to explain the request.

Use the exact date or wording from the complete document. Add the document name and page or section when you can.

Use exact wording when you have it. You may skip this question and return later.

Copy dates and instructions exactly from the complete notice, plan, policy, decision, or other source. Do not rely on this organizer to calculate a deadline.

Include the document name, page or line, exact quote, and anything that still needs to be checked.

List questions for an official source, benefits counselor, accredited representative, lawyer, or other qualified professional.

Write small, specific actions such as checking an official source, requesting a record, calling a benefits counselor, or finding qualified help. Verify any time limit separately.