Integrated Community Employment (ICE) Reporting Form
for Supported Employment Reporting, Benefits Planning Referrals, and Income Disregard

The Division of Developmental Disabilities (DDD) has developed a streamlined process of employment/income reporting, Benefits Counseling referrals, and Income Disregard submission through the completion of one form called the Integrated Community Employment Reporting Form (ICE-RF).

***Individuals will now fill out the revised ICE-RF and submit it only to DDD. Forms will no longer need to be submitted to the Department of Human Services.***

How is this different from the previous ICE form?
The new form asks for some additional information, and includes a new page asking if you want to accept or decline benefits planning.

What else has changed?
The Division of Developmental Disabilities will now receive all ICE-RF forms.

    1. DDD will manage and track the submissions to the Department of Human Services (DHS) for the Income Disregard. DDD will submit the forms to DHS within the month they are received, and follow up with DHS if needed.
    2. DDD will forward referrals to The Sherlock Center for Benefits Planning. The Sherlock Center will contact you and/or your agency to arrange for the Benefits Plan.

Who Needs to Use This Form?
All individuals receiving services through DDD are required to report income and employment. The ICE-RF should be completed if any of the following apply:

    1. You get a new job, a second job, change jobs, get a promotion, leave your job, or have another change in your employment;
    2. You have a change in income, such as getting a raise;
    3. You permanently get more hours at your current job (such as going from 10 hours per week to 15);
    4. You would like to receive benefits counseling

If you have any of those changes, please email DDD the completed form with the following documents:

    1. Paystubs for 4 weeks showing your earnings
    2. OR
    3. Automatic deposit documentation from your employer for a period of 4 weeks
    4. OR
    5. Self employment earnings over 4 weeks

Send these documents to DDD at the email: BHDDH.ICE@bhddh.ri.gov. If you have any questions, please contact Tracey Cunningham at Tracey.Cunningham@BHDDH.ri.gov or your assigned social caseworker.