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annual reassessment for redetermination. Eligibility Worker Referral This form is used by the EW to make a referral to the APS worker to request assessment for guardianship. Notice of Action (for AG) This form is used to inform individuals the action taken by the LDSS. Used for application approvals, denials, redeterminations, changes and advance notices. Provider/DSS Communication Form This form is used by both provider and the LDSS to exchange information regarding eligibility, payment, admissions and discharges, death or any other pertinent information known to the provider that might cause a change in the eligibility status. Transfer of Resources Notice This form is used to notify individuals the actions taken by the LDSS regarding resource transfers. Statement of Funds Provided to Another This form is used by the individual to report funds given to another