• Host Home Inquiry

    Host Home Inquiry

  • Before completing this form, you should review the eligibility & requirements for participating in the program. You can review Frequently Asked Questions or chat with our agent by clicking the more questions link below. 

    Information Links
    Host Home Info  |  Frequently Asked Questions  |  More questions?

    Please answer the following questions to help us determine if your household meets the initial Georgia DBHDD eligibility requirements for the Host Home/Life-Sharing program. This brief screening ensures your home aligns with state-mandated relationship and capacity standards before you begin the full application.

  • Format: (000) 000-0000.
  • So we can assist you better, what is your main reason for filling out this form today?

  • Understood! You're not quite ready to apply, but you want to learn more.

    Please answer the questions below to assist us in answering your questions about becoming a host home provider. You can add your questions or comments prior to submitting the form. 

    Learn More: Read about the rules for Host Homes on our website.

  • Quick Eligibility Check

    Note: For the purpose of this survey, "You" refers to the primary homeowner or lessee applying to be the Host Home provider.
  • Are you currently employed by Caring Hands United?*
  • Do you currently manage the day-to-day operations of another residential location*
  • Do you already have an individual in mind who would be placed in your home as a host home client?*
  • Are you related to the individual you wish to serve by blood or marriage?*
  • Does the individual live with you?*
  • Are you currently the legal guardian, conservator, or healthcare agent for the individual who would live in your home?*
  • Does anyone in your home receive in-home support services under COMP/NOW or any other Medicaid waiver programs?*
  • Have you or another member of your household ever provided Host Home services, Personal Care Home Services or other similar residential services?*
  • Please select all services you or your household members have provided currently or in the past?*
  • Are you and every other member of the household willing to undergo general health examination?*
  • Are you and every other member of the household aged 18 or older willing to undergo a fingerprint background check?*

  • Thank you for your interest in Caring Hands United's Host Home program.

    Based on your responses, your current household setup does not meet the specific DBHDD requirements for the Host Home program (e.g., relationship restrictions or household capacity limits).

    Learn More: Read about the rules for Host Homes on our website.

  • Service Area Check

    Please enter your zip code below, then press the "Check Service Area" button to see if your home is within in our service area.

  • Please enter your zip code below, then press the "Check Service Area" button to see if your home is within in our service area.

  • Great news! We are seeking host home providers in your area!

    Please continue filling out the form and a representative will get back to you shortly.

  • Good news: We are working to expand our service area!

    Please continue filling out the form and a representative will get back to you soon.

    • Click here to provide optional information to help us respond to your inquiry 

    • Host Home Location Information

      The questions below are optional but helpful in providing a more thorough response to your inquiry.

    • The questions below are optional but helpful in providing a more thorough response to your inquiry. When done, please remember to click the Submit button.

    • Is this address your primary home where Host Home services would be provided?*
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