Authority: IC 12-9-2-3; IC 12-11-1.1-9; IC 12-11-2.1-12

Affected: IC 12-11-1.1; IC 12-11-2.1

Sec. 2. The personal and demographic information section shall contain the following:

1. (1) The individual's last name, first name, and middle initial.
2. (2) The individual's address.
3. (3) The individual's date of birth.
4. (4) If applicable, the individual's Medicaid recipient number.
5. (5) The individual's legal status.
6. (6) The individual's current living arrangement.
7. (7) The individual's Social Security number.
8. (8) The individual's medical insurance information.
9. (9) An indication of whether or not the individual is in school, is employed, or has another daily routine. If the individual has another daily routine, the daily routine shall be described.

(Division of Disability, Aging, and Rehabilitative Services; 460 IAC 7-5-2; filed Apr 21, 2003, 9:20 a.m.: 26 IR 2873; readopted filed Nov 30, 2009, 9:33 a.m.: 20091223-IR-460090857RFA; readopted filed Jul 1, 2015, 2:54 p.m.: 20150729-IR-460150144RFA; readopted filed Aug 18, 2021, 10:01 a.m.: 20210915-IR-460210198RFA; readopted filed Oct 8, 2025, 3:17 p.m.: 20251105-IR-460240500RFA)