Highlighted Topics

• 2008-09 Governor’s Budget—California Department of Aging (CDA)
• Be Prepared California
• Get Healthy California
• Health Care Reform
• Long-Term Care Guide
• Security Awareness Training
• Senate Recognizes Department of Aging for Health Promotion in Workplace

Latest News

• Tips to Prevent Heat Related Illness
• 2008 Economic Stimulus Rebate Information
  • Scams - An IRS Warning
• Medicare Fraud Toolkit to Assist Consumers in Protecting Their Medicare Benefits from Fraud and Abuse.
• Do you know, after February 17th, 2009, all full power television stations will broadcast in digital signals only ?
  
• Information for Homeowners Facing Forclosure

Upcoming Conferences & Events

• August 24-27, 2008 16th Annual National Alzheimer's Association Dementia Care Conference

Health Insurance Counseling and Advocacy Program (HICAP)- Reporting Instructions and Forms

Current Forms

• Overview & Instructions for the Quarterly Aggregate HICAP Report (rev. 11/2006)
• Overview & Instructions for the Intake/Counseling and Addendum Forms (rev. 06/2006)

The following forms are models to use as data collection and are not sent to the Department. These forms are meant as a convenience to you and may be revised for the specifics of your program.

• MODEL HICAP Intake/Counseling Form (CDA 264A) (rev. 12/2005)
• MODEL HICAP Intake/Counseling Form Addendum (CDA 264B) (rev. 12/2005)
• MODEL HICAP Public and Media Activity Form
• MODEL HICAP Legal Performance Report

The following forms are official forms for submission to CDA. These may not be modified. Any variations of the official forms will be returned.

• Quarterly Aggregate HICAP Report Form (CDA 1005) (rev. 08/2007)
• Counselor Registration / Information Form (CDA 1012) (rev. 09/2007)

HICAP Intake/Counseling Form and Quarterly Aggregate Form to be used July 1, 2008!

• MODEL HICAP Intake/Counseling Form Instructions (rev. 01/2008)
• MODEL New HICAP Intake/Counseling Form (CDA 264) (rev. 01/2008) (Updated Annually)
• Quarterly Aggregate HICAP Report Instructions (rev. 01/2008)
• Quarterly Aggregate HICAP Report Form (CDA 1005) (rev. 01/2008)

NOTE: All documents are available in various formats, i.e. pdf, rtf, xls or doc. You can download any of the readers from our Download Tools area.. If you have questions about the HICAP Reporting Forms or Instructions, please call (916) 419-7543.