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It explains update timing for Federal Poverty Levels and AGNES renewals, requirements such as providing a birthdate, limits on completing only specific pages, and whether new AGNES forms are needed after service changes. It also covers permitted ink, storage, serving rules for Title III-C2, assistance from grantee staff, emergency contact needs, disability definition, and record retention for six years.",{"@graph":63,"@context":118},[64,80,101],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/aging-needs-evaluation-summary-agnes-faq-sheet/307056/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/aging-needs-evaluation-summary-agnes-faq-sheet/307056.png","ImageObject",442,249,{"name":88,"@type":89},"Quinn","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-16","2026-09-19",true,{"@type":98,"interactionType":99,"userInteractionCount":73},"InteractionCounter",{"@type":100},"ViewAction",{"@type":102,"mainEntity":103},"FAQPage",[104,110,114],{"name":105,"@type":106,"acceptedAnswer":107},"Who can sign the “Use of Information” section on the AGNES document?","Question",{"text":108,"@type":109},"Because the document contains protected health information, the appropriate signature can be from the individual who can consent for themselves, or from another person acting on the individual’s behalf with healthcare decision-making authority.","Answer",{"name":111,"@type":106,"acceptedAnswer":112},"What should providers do if a participant cannot sign the AGNES for themselves but consents verbally or by gesture?",{"text":113,"@type":109},"A program staff member can record the consent by documenting it as such and then providing their own signature, date, and time.",{"name":115,"@type":106,"acceptedAnswer":116},"How is income handled for AGNES-related poverty statistics—gross or net?",{"text":117,"@type":109},"The document states this is not specified by the Department of Health and Human Services. 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Answer: Since there is information that is considered protected health information on this document, an appropriate signature would be either 1) the individual, who has the capacity to consent for themselves; or 2) another acting on behalf of the individual and possessing healthcare decision-making authority for the individual.  \nQuestion: What if a participant is unable to sign the AGNES document for themselves and has no one else acting as a healthcare decision-making authority?  \nAnswer: If a participant in unable to sign for themselves but verbalizes or gestures consent, then a program staff member can record this consent by documenting as such and providing their own signature, date, and time.  \nQuestion: Do the Federal Poverty Levels (FPL) change every year?  \nAnswer: Yes. The Federal Poverty Levels are updated every year by the federal government. The AGNES will be updated each year to reflect these changes.  \nQuestion: Is income based on gross or net?  \nAnswer: This is not specified by the Department of Health and Human Services. The Census Bureau uses a standard definition of income for computing poverty statistics.  \nQuestion: Is there a Spanish AGNES available?  \nAnswer: When applicable, the Community Living Section (CLS) will provide an electronic copy of a Spanish version for the AGNES document. This will be available for download on the CLS website, or you can contact CLS for the most recent copy. The Spanish version will follow the same question sequence as the English version for ease of entry into the A&D data system.  \nQuestion: Does an eligible participant have to complete all of the pages in the AGNES? Answer: No. This varies depending on what program(s) the eligible participant wants to participate in. Each page of the AGNES has a footnote that identifies which programs the page corresponds to and needs to be completed for.  \nQuestion: Does a volunteer have to complete the AGNES?  \nAnswer: No. There is a volunteer form template that providers can choose to use, or they may develop their own volunteer form. The AGNES should only be completed by volunteers age 60 and older, if they choose to complete the form.  \n\n| Stefan Johansson,\u003Cbr>Interim Director | Mark Gordon\u003Cbr>Governor |\n| --- | --- |\n\nQuestion: If an eligible participant completes the 1st page will the AGNES be accepted?  \nAnswer: Yes.  \nQuestion: How long do providers have to complete an annual renewal on an AGNES for the Title III programs before it expires?  \nAnswer: The AGNES should be completed within 30 calendar days of the “renewal date”.  \nQuestion: If the eligible participant only completes the legal name and signs the release form can they participate in the WyHS and Title III Programs?  \nAnswer: No. At minimum, a birthdate must be provided (either verbal or written to confirm eligibility of the program) .  \nQuestion: If the eligible participant’s completes everything except for the poverty question and question six on the Nutrition Risk Assessment, can they participate?  \nAnswer: Yes. The minimum requirement is a birth date. This is to determine eligibility.  \nQuestion: If an eligible participant is participating in III-B and becomes ill and needs IIIC2 services, can they just add the extra page to receive the extra services?  \nAnswer: No. A new AGNES must be completed.  \nQuestion: If an eligible participant on the C1 program becomes ill and needs the C2 program for a temporary time, is a new AGNES required?  \nAnswer: No. Please refer to the C1 policies and procedures for this situation.  \nQuestion: If an eligible participant is on WyHS and discontinues the services but is now receiving III-C1 and III-B services, do they need to complete a new AGNES?  \nAnswer: No, as long as the AGNES is current.  \nQuestion: Do eligible particip","cbCaioQTtEnxZuKC","https://ap.wps.com/l/cbCaioQTtEnxZuKC","pdf",516281,"English","# FAQ\n## Signing and consent\n## Eligibility, page completion, and renewals\n## Program-specific rules and service changes\n## Handling, storage, and retention","[{\"question\":\"Who can sign the “Use of Information” section on the AGNES document?\",\"answer\":\"Because the document contains protected health information, the appropriate signature can be from the individual who can consent for themselves, or from another person acting on the individual’s behalf with healthcare decision-making authority.\"},{\"question\":\"What should providers do if a participant cannot sign the AGNES for themselves but consents verbally or by gesture?\",\"answer\":\"A program staff member can record the consent by documenting it as such and then providing their own signature, date, and time.\"},{\"question\":\"How is income handled for AGNES-related poverty statistics—gross or net?\",\"answer\":\"The document states this is not specified by the Department of Health and Human Services. The Census Bureau uses a standard income definition to compute poverty statistics.\"}]","Aging Needs Evaluation Summary (AGNES) FAQ Sheet | PDF",1789843584]