Skip to main content
The PICS office will be closed on July 4 and 5.
Toggle Mobile Nav
Search
Main Navigation - Full
Services
PICS Services
Community First Services and Supports
Consumer Directed Community Supports
Consumer Support Grant
Individualized Home Supports
Individual Private Pay
Participants
Information for Participants
Managing Services with PICS
Online Portal
Forms
Electronic Visit Verification
Resources & Policies
Participant FAQs
PICS Merchandise
Community Resources
Pay Your Bill Online
Workers
Information for Workers
Becoming a Worker
Worker Benefits
Worker Forms
Electronic Visit Verification
Worker FAQs
Individualized Home Supports Training
Payroll
Blog
Blog & Updates
E-Newsletter Sign Up
Social Media
About
About
Services with PICS
Servicios con PICS (Spanish)
Cov kev pab cuam nrog PICS (Hmong)
Adeegyada leh PICS (Somali)
Anti-Racism & Social Justice
Contact
Header Menu
651.967.5060
Mon. - Fri. | 8:30am - 4:30pm
Enroll/Refer
Participant Login
Enroll with PICS | Make a Referral
Breadcrumb
/
Home
/
Enroll with PICS | Make a Referral
Participant's first and last name (person receiving service)
First and last name
Service type:
Consumer Support Grant (CSG).
Consumer Directed Community Supports (CDCS).
Individualized Home Supports without training (Traditional) - This service includes respite, homemaker, night supervision, chore, caregiver living expense.
Individual Private Pay.
Unsure.
What is the expected start date of the services?
Start date
Who is completing this form?
Individual who will receive services.
Family member or friends.
County Representative.
Case Manager.
Care Coordinator.
Support Planner.
Other.
Your first and last name
Your phone number
Your email
Will you manage the Participant's services?
Yes
No
Who will be the Participant's Representative?
What is their relationship to the Participant?
Representative's phone number
Representative's email
Preferred method of contact:
Phone
Email
Does the Representative need an interpreter?
Yes
No
Do you need an interpreter?
Yes
No
Please list their primary or preferred language
Please list your primary or preferred language
How did you hear about PICS?
Case Manager/Care Coordinator/Support Planner.
Newspaper/online ad.
Internet search.
Friend or family member.
Conference or event.
PICS or LSS employee.
Department of Human Services' (DHS) Financial Management Service (FMS) website.
Other.
Any comments or questions you have about starting services with PICS?
Leave this field blank
