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Transfer of Resources Notice The Transfer of Resources Notice is used to notify an individual that they are ineligible for a period of time due to the uncompensated transfer of resources, to inform them of their right to claim undue hardship and to notify them of any adjustments made to the period of ineligibility. See Chapter G. Initial Application/Reapplication The “Transfer of Resources Notice” is to be sent with the Notice of Action (for AG)”. Renewal or Change The “Transfer of Resources Notice” is to be sent with the “Notice of Action (for AG)” Provider/DSS Communication Form The Provider/DSS Communication Form is used to notify the provider of the eligibility decision. The form is also used as means of communication between the local DSS and the assisted living facility or adult foster care home provider. They can exchange information regarding: The AG and Medicaid eligibility status of an individual; Admission or discharge of an individual to home, hospital, another ALF/AFCH, or an institution, or to report the death of an individual; Other information known to the provider that might cause a change in the eligibility status. Use of the Form The form may be initiated by either the local DSS or the provider of care. The local DSS must complete the form for each applicant at the time initial eligibility is determined. A new form must be prepared by the local DSS whenever there is any change in individual’s circumstances that results in the individual’s