The Provider Closure Notification Form (DP 1061) is used to ensure that all ODP waiver and system requirements are met for any provider who no longer intends to provide ODP Consolidated, Person/Family Directed Support (P/FDS) and/or Community Living Waiver services. The DP 1061 and its instructions have been updated to comply with 55 Pa Code § 6100 requirements. Additionally, the form has been formatted to be submitted electronically. This new version of the form (11/19) should be used going forward effective immediately. NOTE: This form is not to be used when providers are ONLY discharging individuals. Providers shall adhere to requirements contained in 55 Pa. Code § 6100.304. With the release of this announcement, ODP Communication Number: 050-17 Provider Closure Notification Form (DP 1061) is obsoleted.

Attachment 1: 20-009:  Provider Closure Notification Form (DP 1061)