PCCP Request Form
NOTICE: Due to the increased volume of requests, all communication from DSDS will be directed to the email address provided, unless a call is warranted. Please ensure you are checking your email address for the latest information related to your request.
Hello and welcome to the DSDS Online PCCP Request Form!
The PCCP Request Form is used to request changes to HCBS care plans for active participants receiving State Plan Services, Aged & Disabled Waiver services, Adult Day Care Waiver services, or Independent Living Waiver services administered by the Division of Senior and Disability Services.
Note: This form is to be used for individuals who are currently receiving HCBS through DSDS. Please refer to the Online HCBS Referral Form to submit a new referral for services.
Note: It is illegal in the State of Missouri to willfully provide false information in an attempt to obtain any public assistance benefits, programs, and services. Any person who willfully provides false information in an attempt to obtain any public assistance benefits, programs, and services shall be guilty of the crime of stealing. Please reference Missouri Statue 205.967 for more information.
Note: Incomplete submissions will not be processed, please complete the entire form.