LDSS-3633. Individual Resident Fund Record Account

Form LDSS-3633, the Individual Resident Fund Record Account, is used to document the financial information of a resident of a long-term care facility and to track their income and expenses. It is typically used by facilities providing services such as nursing homes, intermediate care facilities, and adult homes. The form is maintained by the facility and must be updated regularly. This form includes sections for the resident's name, date of birth, Social Security number, and address, as well as the name of the facility, the name of the account manager, and the date the account was opened. This form also includes sections for the amount of the resident's income and expenses, as well as the balance of the resident's fund account. All income, expense, and balance information must be documented accurately and updated regularly.

Important fields in this form include the name of the resident, the date of birth, the Social Security number, and address of the resident, the name of the facility, and the name of the account manager. Additionally, all income, expense, and balance information must be accurately documented and updated regularly. When filling out this form, it is important to include all relevant information and to ensure that all information is accurate and up to date.

An example situation in which this form would be used is when a resident of a long-term care facility needs to have their financial information documented and tracked. This form is beneficial in documenting the resident's income and expenses, as well as tracking the balance of the resident's fund account. Additionally, this form is useful in providing a record of the resident's financial information that can be accessed by the facility, the account manager, and the resident themselves.

When filling out this form, it is important to include all relevant information and to ensure that all information is accurate and up to date. Additionally, any related forms or alternative forms that may exist should be considered when filling out this form. Additionally, any additional documents that may be required for filling and completing this form should be gathered as well.