subject_line
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Asterisks denote required items
Colorado Office of the Child's Representative
Confirmation of Case Consultant II Billing Rate
If you already have a CARES account with a Case Consultant (CC)
persona
, you may complete this form to request the $66/hr
Case Consultant II
billing rate. If you work for multiple
offices
in CARES, you only need to complete this form once.
OCR will verify your CARES status and license(s) below. Do not use this form if you are
not
already qualified to use CARES as outlined in OCR's
Billing Policies and Procedures
.
Your Name
*
Your Email
*
🛈
Confirm Email
*
🛈
*
Required Info
I meet the Office of the Child’s Representative’s (OCR’s) qualifications for the $66/hr CC payment rate because I have the following active license(s):
(Select all that apply.)
*
Licensed Clinical Social Worker
Licensed Professional Counselor
Licensed Marriage and Family Therapist
Current License Number
*
Signature
Type your name and date below to certify that the information you provided here is true and accurate to the best of your knowledge. Typed signature shall suffice as if original.
Name
*
Date
*
Click "Submit" to complete your form
.
You will receive a summary at your email address provided.