Individual’s Type of Residential Placement (check only one) Independent Living (lives by self or with roommate) 7 - 15 Bed ICF/ID Group Home Family Home (lives with family member or guardian) > 15 Bed ICF/ID Group Home Foster Home Adult Care/Nursing/Rest Homes (homes for aged/disabled) 1 - 6 Bed Adult Care/Nursing/Rest Home 1 Bed Alternative Family Living (AFL) 7- 15 Bed Adult Care/Nursing/Rest Home 2 6 Bed Alternative Family Living (AFL) > 15 Bed Care/Nursing/Rest Home Supervised Living DD Adult Group Home (state funded) 1 3 Bed Supervised Living DD Adult Congregate Care (> 15 Bed) State Developmental Center 4 - 6 Bed Supervised Living DD Adult Psychiatric Hospital Supervised Living DD Minor Group Home (state funded) Neuro Med Treatment Center Other Residential Not Listed Above (Specify Below) 1 3 Bed Supervised Living DD Minor 4 - 6 Bed Supervised Living DD Minor 1 - 6 Bed Residential 7-15 Bed Other Residential > 15 Bed Other Residential ICF/ID Group Home (Medicaid funded) 1 - 6 Bed ICF/ID Group Home Specify Other Residential Oct 2017
Individual’s Type of Residential Placement (check only one) Independent Living (lives by self or with roommate) Family Home (lives with family member or guardian) Foster Home 1 Bed Alternative Family Living (AFL) 2 6 Bed Alternative Family Living (AFL) Supervised Living DD Adult Group Home (state funded) 1 3 Bed Supervised Living DD Adult 4 - 6 Bed Supervised Living DD Adult Supervised Living DD Minor Group Home (state funded) 1 3 Bed Supervised Living DD Minor 4 - 6 Bed Supervised Living DD Minor ICF/ID Group Home (Medicaid funded) 1 - 6 Bed ICF/ID Group Home 7 - 15 Bed ICF/ID Group Home > 15 Bed ICF/ID Group Home Adult Care/Nursing/Rest Homes (homes for aged/disabled) 1 - 6 Bed Adult Care/Nursing/Rest Home 7- 15 Bed Adult Care/Nursing/Rest Home > 15 Bed Care/Nursing/Rest Home Congregate Care (> 15 Bed) State Developmental Center Psychiatric Hospital Neuro Med Treatment Center Other Residential Not Listed Above (Specify Below) 1 - 6 Bed Residential 7-15 Bed Other Residential > 15 Bed Other Residential Specify Other Residential Oct 2017
NC%20SNAP%20Supplemental%20Information%20Sheet%202017.docx